Healthcare Provider Details

I. General information

NPI: 1124453857
Provider Name (Legal Business Name): DIANA M MCINTOSH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SYCAMORE ST
CINCINNATI OH
45202-1305
US

IV. Provider business mailing address

909 SYCAMORE STREET
CINCINNATI OH
45202
US

V. Phone/Fax

Practice location:
  • Phone: 513-352-1342
  • Fax: 513-352-1345
Mailing address:
  • Phone: 513-352-1342
  • Fax: 513-352-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberRN.144833-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: