Provider Demographics
NPI:1801210794
Name:MOSIDI, REUBEN (PHD)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:
Last Name:MOSIDI
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 1:301 MORRISON DR
Mailing Address - Street 2:WAITE HIGH SKILL CENTER
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2124
Mailing Address - Country:US
Mailing Address - Phone:419-671-8900
Mailing Address - Fax:419-671-8895
Practice Address - Street 1:301 MORRISON DR
Practice Address - Street 2:WAITE HIGH SKILL CENTER
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2124
Practice Address - Country:US
Practice Address - Phone:419-671-8900
Practice Address - Fax:419-671-8895
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTU1-00-7971103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool