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General NPI Number Information
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NPI Number | 1316486145
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Entity Type | Individual
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Provider Name | PAUL DEARDORFF PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 4217 SMITH RD
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City | CINCINNATI
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State | OH
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Zip | 45212-4107
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Country | US
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Telephone | 513-871-7285
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Fax | 513-871-7281
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Provider Business Mailing Address
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Address Line | 4217 SMITH ROAD
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City | CINCINNATI
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State | OH
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Zip | 45212
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20042424A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2640
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License Number State | OH
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