Healthcare Provider Details

I. General information

NPI: 1568228567
Provider Name (Legal Business Name): ZACHARY WOOD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE, ML 3015
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE, ML 3015
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4336
  • Fax: 513-636-7756
Mailing address:
  • Phone: 513-636-4336
  • Fax: 513-636-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08987
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: