MEDICARE: DR. RICHARD EDMUND SEXTON PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4039	OH

General Provider Information

NPI Number	:	1427149533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD EDMUND SEXTON PH.D

Provider Business Mailing Address
First Line	:	1350 MICHIGAN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2702
Country	:	US
Telephone Number	:	513-404-7202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 MICHIGAN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2702
Country	:	US
Telephone Number	:	513-404-7202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/09/2007

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