Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4189 | OH |
N | 103T00000X | Psychologist | 4189 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 90281CCDCIII | OH |
NPI | 1184608523 |
---|---|
Provider Name | Dr. Stephen Wayne Emerick |
First Address | Centerville, OH 45459-4245 |
Second Address | Centerville, OH 45459-8911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0738027 | (05) | OH |
R71474 | (02) | OH |