Provider Demographics
NPI:1962543470
Name:HANEY, RONALD E (LISW-SUPV)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:E
Last Name:HANEY
Suffix:
Gender:M
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1983
Mailing Address - Country:US
Mailing Address - Phone:937-294-4623
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-1921
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:937-534-1350
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI5621104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015981Medicare ID - Type Unspecified
OH2015981Medicare UPIN