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General NPI Number Information
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NPI Number | 1154300077
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Entity Type | Individual
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Provider Name | RANDOLPH L PRESHAW PHD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9403 KENWOOD RD STE B209
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City | CINCINNATI
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State | OH
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Zip | 45242-6895
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Country | US
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Telephone | 513-793-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 9109 SHADETREE DR
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City | CINCINNATI
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State | OH
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Zip | 45242-7529
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Country | US
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Telephone | 513-891-7833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3592
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License Number State | OH
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