Provider Demographics
NPI:1174613467
Name:MORTIMER, MARGIE W (MA, LPCC)
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:W
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 VICTORIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1431
Mailing Address - Country:US
Mailing Address - Phone:513-321-7702
Mailing Address - Fax:513-321-4703
Practice Address - Street 1:10979 REED HARTMAN HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-2800
Practice Address - Country:US
Practice Address - Phone:513-321-7702
Practice Address - Fax:513-321-4703
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
140050555854OtherHUMANA
2003888OtherCIGNA BEHAVIORAL HEALTH
NYNL724OtherEMPIREBLUECROSSBLUESHIELD
22000000222923OtherANTHEM
5206754OtherAETNA
1-9H5565OtherHORIZON HEALTH
22000000222920OtherANTHEM