Healthcare Provider Details

I. General information

NPI: 1770693889
Provider Name (Legal Business Name): GEROPSYCHOLOGY CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 MT CARMEL TOBASCO RD STE 306D
CINCINNATI OH
45255
US

IV. Provider business mailing address

PO BOX 30264
CINCINNATI OH
45230
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-3500
  • Fax: 513-233-3501
Mailing address:
  • Phone: 513-233-3500
  • Fax: 513-233-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5372
License Number StateOH

VIII. Authorized Official

Name: DR. SUZANNE M NORMAN
Title or Position: OWNER
Credential: PHD
Phone: 513-233-3500