Provider Demographics
NPI:1134505878
Name:KANE, CONSTANCE ANN (MSW, LSW)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANN
Last Name:KANE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OVERBROOK DR STE C
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1168
Mailing Address - Country:US
Mailing Address - Phone:513-372-2604
Mailing Address - Fax:
Practice Address - Street 1:30 OVERBROOK DR STE C
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1168
Practice Address - Country:US
Practice Address - Phone:513-372-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0027721104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1134505878Medicaid