Healthcare Provider Details

I. General information

NPI: 1588938781
Provider Name (Legal Business Name): FRED MELOWSKY, PHD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E. HOLLISTER STREET
CINCINNATI OH
45219-1107
US

IV. Provider business mailing address

26 E HOLLISTER STREET
CINCINNATI OH
45219-1107
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-5001
  • Fax: 513-621-5008
Mailing address:
  • Phone: 513-621-5001
  • Fax: 513-621-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: FRED MELOWSKY
Title or Position: PRESIDENT
Credential: PH.D
Phone: 513-621-5001