Healthcare Provider Details

I. General information

NPI: 1063449114
Provider Name (Legal Business Name): EDWIN T BARRETT JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE SUITE 3200
CINCINNATI OH
45219
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8730
  • Fax: 513-475-8033
Mailing address:
  • Phone: 513-585-5504
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: