Active NPI
Scott T. Kidd, PSY.D.
- Clinical Psychologist
- Fairborn, OH
National Provider Identifier
1710007109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5975
- Practice address
- 2378 National Rd
Fairborn, OH 45324-2009 - Phone
- (937) 879-7996
- NPI assigned
- Mar 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5975 | OH | Primary |
| Forensic Psychologist | 103TF0200X | 5975 | OH |
Addresses
Primary practice location
2378 National Rd
Fairborn, OH 45324-2009
Mailing address
2378 National Rd
Fairborn, OH 45324-2009
Phone (937) 879-7996
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5975 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277337600000",
"number": "1710007109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2378 NATIONAL RD",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453242009",
"telephone_number": "937-879-7996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2378 NATIONAL RD",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453242009",
"telephone_number": "937-879-7996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDD",
"first_name": "SCOTT",
"middle_name": "T.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-30",
"last_updated": "2010-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "5975",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "OH",
"license": "5975",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.