MEDICARE: KATHRYN MARIAH ZUMBERG SMITH 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	P.07923	OH

General Provider Information

NPI Number	:	1851626873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MARIAH ZUMBERG SMITH PH.D.

Provider Business Mailing Address
First Line	:	3808 PAXTON AVE STE 14A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-2399
Country	:	US
Telephone Number	:	513-549-1284
Fax Number	:

Provider Business Practice Location Address
First Line	:	5758 GLENGATE LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1913
Country	:	US
Telephone Number	:	513-549-1284
Fax Number	:

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

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/16/2021

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