Provider Demographics
NPI:1912516808
Name:WARE, DEENA (LSW)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43071-9670
Mailing Address - Country:US
Mailing Address - Phone:740-345-5437
Mailing Address - Fax:740-745-3429
Practice Address - Street 1:8135 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:ST LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:43071-9670
Practice Address - Country:US
Practice Address - Phone:740-975-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1904256104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker