Healthcare Provider Details

I. General information

NPI: 1790828515
Provider Name (Legal Business Name): ALBERT W. SCOVERN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S 5TH ST
COLUMBUS OH
43206-1202
US

IV. Provider business mailing address

468 W 3RD ST
LEXINGTON KY
40508-3512
US

V. Phone/Fax

Practice location:
  • Phone: 614-562-4465
  • Fax:
Mailing address:
  • Phone: 859-281-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number856
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3499
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: