Provider Demographics
NPI:1851468185
Name:MEI-TAL, RENA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RENA
Middle Name:
Last Name:MEI-TAL
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 1:71 E HOLLISTER ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1703
Mailing Address - Country:US
Mailing Address - Phone:513-860-0801
Mailing Address - Fax:513-333-3024
Practice Address - Street 1:71 E HOLLISTER ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1703
Practice Address - Country:US
Practice Address - Phone:513-860-0801
Practice Address - Fax:513-333-3024
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5459103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000036844OtherANTHEM PROVIDER ID
OH2077667Medicaid
OH5129685OtherAETNA PROVIDER ID
OH506237OtherVALUE OPTIONS PROVIDER ID
OH222692OtherMHN PROVIDER ID
OH000000036844OtherANTHEM PROVIDER ID
OH5129685OtherAETNA PROVIDER ID