Healthcare Provider Details

I. General information

NPI: 1306904693
Provider Name (Legal Business Name): AUGUST VENTURA EDD PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WELLINGTON PLACE
CINCINNATI OH
45219-1710
US

IV. Provider business mailing address

126 WELLINGTON PLACE
CINCINNATI OH
45219-1710
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-0471
  • Fax: 513-421-4941
Mailing address:
  • Phone: 513-381-0471
  • Fax: 513-421-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1885
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: