Provider Demographics
NPI:1841412897
Name:ALBERT W. SCOVERN, PH.D.
Entity type:Organization
Organization Name:ALBERT W. SCOVERN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-562-4465
Mailing Address - Street 1:520 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1202
Mailing Address - Country:US
Mailing Address - Phone:614-562-4465
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3499261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)