Organization
LEGACY PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME A GABIS PSYD (OWNER)
(513) 699-9240
Entity
Organization
Contact information
Practice address
7105 HAMILTON AVE, CINCINNATI, OH 45231-5218
(513) 699-9240
(513) 681-8959
Mailing address
PO BOX 634927, CINCINNATI, OH 45263-0042
(513) 891-2813
(513) 793-1032
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
104100000X
Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2922476
—
OH
01
—
DE6598
RR MEDICARE
—
Enumeration date
07/17/2006
Last updated
09/17/2009
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