Provider Demographics
NPI:1710420773
Name:CHIN, FREDRICK
Entity type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2355
Mailing Address - Country:US
Mailing Address - Phone:513-924-8200
Mailing Address - Fax:513-924-8201
Practice Address - Street 1:11550 WINTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2355
Practice Address - Country:US
Practice Address - Phone:513-924-8200
Practice Address - Fax:513-924-8201
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OHP.08693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor