Healthcare Provider Details

I. General information

NPI: 1407907231
Provider Name (Legal Business Name): PAUL SAMSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NIMITZVIEW DR SUITE 200
CINCINNATI OH
45230-4314
US

IV. Provider business mailing address

4240 HUNT RD
CINCINNATI OH
45242-6612
US

V. Phone/Fax

Practice location:
  • Phone: 513-688-7555
  • Fax: 513-688-0591
Mailing address:
  • Phone: 513-891-0650
  • Fax: 513-891-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: