Basic Information
| Provider Information | |||||||||
| NPI: | 1639782642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANSBERRY | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | MCCALL | ||||||||
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| Credential: | BSW, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 GRANDVIEW AVE APT 204 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410731573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656174237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11156 CANAL RD STE A | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452415816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137726166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.2005333 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.