Provider Demographics
NPI:1487705869
Name:NATHAN, NANCY S (LISW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:NATHAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2567 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2018
Mailing Address - Country:US
Mailing Address - Phone:513-259-3663
Mailing Address - Fax:513-871-3262
Practice Address - Street 1:2567 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2018
Practice Address - Country:US
Practice Address - Phone:513-259-3663
Practice Address - Fax:513-871-3262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0007225104100000X
OHF119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000106836OtherANTHEM PROVIDER NUMBER