Provider Demographics
NPI:1861739625
Name:BROCK, CHRISTINA (LISW-S)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BROCK
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 1:1329 E KEMPER RD STE 4100-J
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-5101
Mailing Address - Country:US
Mailing Address - Phone:513-341-8729
Mailing Address - Fax:
Practice Address - Street 1:1329 E KEMPER RD STE 4100-J
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-5101
Practice Address - Country:US
Practice Address - Phone:513-341-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1201391-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical