Kimberly E Anzek, PH.D
Individual provider Active NPI Psychologist · Centerville, OH
NPI 1922493535 · NPPES record last updated Jul 30, 2019
Key facts
- NPI
- 1922493535
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 7288 (OH)
- Practice address
- 330 N Main St Ste 104
Centerville, OH 45459-4459 - Phone
- (937) 813-6240
- Fax
- (937) 619-8202
- NPI assigned
- Mar 31, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7288 | OH | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mosaic Psychological Services, LLC | Current |
Accepting new patients |
Locations
37 Iron Gate Park Dr
Dayton, OH 45459
Phone (937) 813-6240
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 7288 | OH | Yes |
Addresses
Primary practice location
330 N Main St Ste 104
Centerville, OH 45459-4459
Mailing address
330 N Main St Ste 104
Centerville, OH 45459-4459
Phone (937) 813-6240
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0315928 | Medicaid | OH |
Other providers in Centerville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.