Active NPI
David V. Surnbrock, LISW
- Clinical Social Worker
- Fairfield, OH
National Provider Identifier
1760570477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I 0008354
- Practice address
- 1251 Nilles Rd
Suite 5
Fairfield, OH 45014-7206 - Phone
- (513) 939-0300
- Fax
- (513) 939-0310
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I 0008354 | OH | Primary |
Addresses
Primary practice location
1251 Nilles Rd
Suite 5
Fairfield, OH 45014-7206
Mailing address
1251 Nilles Rd
Suite 5
Fairfield, OH 45014-7206
Phone (513) 939-0300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I 0008354 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457049600000",
"number": "1760570477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1251 NILLES RD",
"address_2": "SUITE 5",
"city": "FAIRFIELD",
"state": "OH",
"postal_code": "450147206",
"telephone_number": "513-939-0300",
"fax_number": "513-939-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1251 NILLES RD",
"address_2": "SUITE 5",
"city": "FAIRFIELD",
"state": "OH",
"postal_code": "450147206",
"telephone_number": "513-939-0300",
"fax_number": "513-939-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURNBROCK",
"first_name": "DAVID",
"middle_name": "V.",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2016-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I 0008354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.