Provider Demographics
NPI:1679643969
Name:MCLEOD, MARTHA ELIZABETH (MA)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WOOLPER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1217
Mailing Address - Country:US
Mailing Address - Phone:513-221-8623
Mailing Address - Fax:513-221-8623
Practice Address - Street 1:211 WOOLPER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-1217
Practice Address - Country:US
Practice Address - Phone:513-221-8623
Practice Address - Fax:513-221-8623
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI45371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMCSW 05524Medicare ID - Type Unspecified