Healthcare Provider Details

I. General information

NPI: 1912088535
Provider Name (Legal Business Name): KEVIN HOMMEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4200
  • Fax: 866-213-7084
Mailing address:
  • Phone: 513-636-4200
  • Fax: 866-213-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS015646
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: