Provider Demographics
NPI:1962045039
Name:ESHLEMAN LATIMER, SAMUEL ROHAN (MA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ROHAN
Last Name:ESHLEMAN LATIMER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:ROHAN
Other - Last Name:MILLER-ESHLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:994 DANA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1488
Mailing Address - Country:US
Mailing Address - Phone:740-498-1778
Mailing Address - Fax:
Practice Address - Street 1:2621 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1754
Practice Address - Country:US
Practice Address - Phone:513-221-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist