Individual
DINA LEE CONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW-CP
Contact information
Practice address
3050 MACK RD STE 205, FAIRFIELD, OH 45014-5376
(513) 682-6980
(513) 981-5783
Mailing address
3050 MACK RD STE 205, FAIRFIELD, OH 45014-5376
(513) 682-6980
(513) 981-5783
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
12935
SC
1041C0700X
Clinical Social Worker
Primary
I.1303609-SUPV
OH
1041S0200X
School Social Worker
OH3064767
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12935
SC MEDICAL LICENSE
SC
01
—
I.1303609.SUPV
LISW-S
OH
Enumeration date
09/27/2016
Last updated
04/20/2023
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