Healthcare Provider Details

I. General information

NPI: 1184024218
Provider Name (Legal Business Name): VAN T PHAM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 O'VARSITY WAY
CINCINNATI OH
45221-5218
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7700
  • Fax: 513-558-5055
Mailing address:
  • Phone: 513-585-6200
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: