MEDICARE: DR. SUSAN GREENWELL GEOGHEGAN 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	103T00000X	Psychologist	4730	OH
2	103T00000X	Psychologist	0826	KY
3	103T00000X	Psychologist	20042311A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183465000	OTHER	OH	MAGELLAN
2	000000003586	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1811043128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN GREENWELL GEOGHEGAN PH.D.

Provider Business Mailing Address
First Line	:	6003 TAYLOR RIDGE DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1988
Country	:	US
Telephone Number	:	513-777-9588
Fax Number	:

Provider Business Practice Location Address
First Line	:	28208 STATE ROAD 1
Second Line	:
City	:	WEST HARRISON
State	:	IN
Zip	:	47060-9686
Country	:	US
Telephone Number	:	812-576-1600
Fax Number	:	812-576-1602

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	05/28/2009

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