Basic Information
| Provider Information | |||||||||
| NPI: | 1316414675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WEST | ||||||||
| OtherFirstName: | ABIGAIL | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 113 N MIAMI ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450671309 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1131 MANCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450421925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134227016 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2018 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S.1802990 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.