Basic Information
| Provider Information | |||||||||
| NPI: | 1235226127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROSBY | ||||||||
| FirstName: | RAY | ||||||||
| MiddleName: | MCPHAIL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 SUMMIT ROAD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139483600 | ||||||||
| FaxNumber: | 5139488631 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 SUMMIT ROAD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139483600 | ||||||||
| FaxNumber: | 5139488631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4659 | OH | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 283Q00000X | 4659 | OH | N | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0150189 | 05 | OH | MEDICAID |