Provider Demographics
NPI:1649312109
Name:CLEMONS, RON A (LISW)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:A
Last Name:CLEMONS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641030
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264
Mailing Address - Country:US
Mailing Address - Phone:513-942-5300
Mailing Address - Fax:513-942-5033
Practice Address - Street 1:3174 MACK RD
Practice Address - Street 2:UNIT 3
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-942-5300
Practice Address - Fax:513-942-5033
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0004955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker