Provider Demographics
NPI:1902908981
Name:BROERING, NANCY L (LISW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:BROERING
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:OKEANA
Mailing Address - State:OH
Mailing Address - Zip Code:45053-9633
Mailing Address - Country:US
Mailing Address - Phone:513-202-9077
Mailing Address - Fax:
Practice Address - Street 1:1149 STONE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-2763
Practice Address - Country:US
Practice Address - Phone:513-202-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 38221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW16961Medicare ID - Type Unspecified