Provider Demographics
NPI:1891892964
Name:CINCINNATI PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CINCINNATI PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:513-662-8200
Mailing Address - Street 1:2300 MONTANA AVE
Mailing Address - Street 2:SUITE 317
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-3829
Mailing Address - Country:US
Mailing Address - Phone:513-662-8200
Mailing Address - Fax:513-662-8201
Practice Address - Street 1:2300 MONTANA AVE
Practice Address - Street 2:SUITE 317
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3829
Practice Address - Country:US
Practice Address - Phone:513-662-8200
Practice Address - Fax:513-662-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3982103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694995Medicaid
OHCP 12242Medicare ID - Type UnspecifiedMEDICARE