Provider Demographics
NPI:1386829380
Name:KATHLEEN A. MACK, PSY.D,. INC.
Entity Type:Organization
Organization Name:KATHLEEN A. MACK, PSY.D,. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:513-771-8555
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-0674
Mailing Address - Country:US
Mailing Address - Phone:513-771-8555
Mailing Address - Fax:513-771-8556
Practice Address - Street 1:8 TRIANGLE PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3404
Practice Address - Country:US
Practice Address - Phone:513-771-8555
Practice Address - Fax:513-771-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3898103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP05163Medicare PIN
OHR71519Medicare UPIN