Healthcare Provider Details

I. General information

NPI: 1992726327
Provider Name (Legal Business Name): JEROME A GABIS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/24/2014
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: 513-522-0777
  • Fax: 513-522-4577
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 Number4902
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4902
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4902
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: