Provider Demographics
NPI:1891299822
Name:POOLE, E-ZRA ELISE (BSW,LSW)
Entity Type:Individual
Prefix:
First Name:E-ZRA
Middle Name:ELISE
Last Name:POOLE
Suffix:
Gender:F
Credentials:BSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2910
Mailing Address - Country:US
Mailing Address - Phone:937-212-5797
Mailing Address - Fax:
Practice Address - Street 1:2093 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2910
Practice Address - Country:US
Practice Address - Phone:937-212-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2208290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker