MEDICARE: DR. PAUL JOHN DIVINCENZO PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3923	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386740439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JOHN DIVINCENZO PH.D

Provider Business Mailing Address
First Line	:	1019 HILLCREEK LN
Second Line	:
City	:	GATES MILLS
State	:	OH
Zip	:	44040-9630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 NORTHFIELD RD
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1135
Country	:	US
Telephone Number	:	216-518-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. PAUL JOHN DIVINCENZO PH.D” Practice Location

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