Provider Demographics
NPI:1174153464
Name:SHOEMAKER, LISA (LSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHOEMAKER
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 1:1424 WHITAKER LN
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1036
Mailing Address - Country:US
Mailing Address - Phone:513-212-1249
Mailing Address - Fax:
Practice Address - Street 1:3129 SPRING GROVE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1821
Practice Address - Country:US
Practice Address - Phone:513-853-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0600660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker