Healthcare Provider Details

I. General information

NPI: 1346267820
Provider Name (Legal Business Name): LEGACY PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 HAMILTON AVE
CINCINNATI OH
45231-5218
US

IV. Provider business mailing address

PO BOX 634927
CINCINNATI OH
45263-0042
US

V. Phone/Fax

Practice location:
  • Phone: 513-699-9240
  • Fax: 513-681-8959
Mailing address:
  • Phone: 513-891-2813
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JEROME A GABIS
Title or Position: OWNER
Credential: PSYD
Phone: 513-699-9240