Provider Demographics
NPI:1790828515
Name:SCOVERN, ALBERT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:W
Last Name:SCOVERN
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 1:468 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3512
Mailing Address - Country:US
Mailing Address - Phone:859-281-6702
Mailing Address - Fax:
Practice Address - Street 1:520 S 5TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-1202
Practice Address - Country:US
Practice Address - Phone:614-562-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC856103T00000X
OH3499103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist