Healthcare Provider Details

I. General information

NPI: 1568981967
Provider Name (Legal Business Name): DANIEL WHITFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date: 01/22/2018
Reactivation Date: 02/28/2018

III. Provider practice location address

2651 BURNET AVE
CINCINNATI OH
45219-2551
US

IV. Provider business mailing address

2651 BURNET AVE
CINCINNATI OH
45219-2551
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-0000
  • Fax:
Mailing address:
  • Phone: 513-363-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00012
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: