Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | S 0030889 | OH |
NPI | 1003166588 |
---|---|
Provider Name | Mark R Mcclure |
First Address | Cincinnati, OH 45237-3838 |
Second Address | Cincinnati, OH 45237-3838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 12/09/2012 |