Provider Demographics
NPI:1437192044
Name:MADRIGAL, ROBERTO (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:MADRIGAL
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 1:7620 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4204
Mailing Address - Country:US
Mailing Address - Phone:513-891-4621
Mailing Address - Fax:513-891-4621
Practice Address - Street 1:7620 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4204
Practice Address - Country:US
Practice Address - Phone:513-636-4633
Practice Address - Fax:513-636-7743
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4169103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist