Provider Demographics
NPI:1629176854
Name:DAVIS, SUE B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 KENWOOD RD
Mailing Address - Street 2:SUITE B209
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6895
Mailing Address - Country:US
Mailing Address - Phone:513-793-7005
Mailing Address - Fax:513-792-8900
Practice Address - Street 1:9403 KENWOOD RD
Practice Address - Street 2:SUITE B209
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6895
Practice Address - Country:US
Practice Address - Phone:513-793-7005
Practice Address - Fax:513-792-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH44454268OtherUNITED BEHAVIORAL HEALTH
OH44454268OtherUNITED BEHAVIORAL HEALTH