Healthcare Provider Details

I. General information

NPI: 1992234546
Provider Name (Legal Business Name): MARTYN SIMON WHITTINGHAM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HIGHLAND AVE
CINCINNATI OH
45219-2315
US

IV. Provider business mailing address

8032 QUAIL MEADOW LN
WEST CHESTER OH
45069-1990
US

V. Phone/Fax

Practice location:
  • Phone: 513-961-8830
  • Fax:
Mailing address:
  • Phone: 513-827-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: