Provider Demographics
NPI:1386898633
Name:WIRSCH, BECKY J (LISW-S)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:J
Last Name:WIRSCH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1925
Mailing Address - Country:US
Mailing Address - Phone:513-422-7016
Mailing Address - Fax:513-422-5263
Practice Address - Street 1:1490 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3305
Practice Address - Country:US
Practice Address - Phone:513-881-7189
Practice Address - Fax:513-881-7188
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2002174-SUPV1041C0700X
OHS0700294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker