Provider Demographics
NPI:1326189556
Name:REED, MARVIN DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DOUGLAS
Last Name:REED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7588 CENTRAL PARKE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6860
Mailing Address - Country:US
Mailing Address - Phone:513-779-7400
Mailing Address - Fax:513-779-7426
Practice Address - Street 1:7588 CENTRAL PARKE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6860
Practice Address - Country:US
Practice Address - Phone:513-779-7400
Practice Address - Fax:513-779-7426
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2347103TF0200X, 103TC0700X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMASP02991Medicare ID - Type UnspecifiedNATIONAL PROVIDER ID NBR
OHRECP19132Medicare PIN