MEDICARE: PAUL J 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	3923	OTHER	OH	UNITED HEALTH CARE
2	000000141048	OTHER	OH	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3923	OTHER	OH	KAISER
5	3923	OTHER	OH	EMERALD HEALTH
6	4073101	OTHER	OH	AETNA
7	3923	OTHER	OH	TRI CARE
8	3923	OTHER	OH	VALUE OPTION
9	288460455007	OTHER	OH	MEDICAL MUTUAL
10	3923	OTHER	OH	MBHS
11	3923	OTHER	OH	COMPSYCH
12	3923	OTHER	OH	CIGNA
13	3923	OTHER	OH	UNITED BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1942358148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL J DIVINCENZO PH.D

Provider Business Mailing Address
First Line	:	5311 NORTHFIELD RD
Second Line	:
City	:	BEDFORD HTS
State	:	OH
Zip	:	44146-1135
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	:	PRESIDENT
Name	:	DR. PAUL JOHN DIVINCENZO
Credential	:
Telephone Number	:	216-518-3900

Provider Enumeration Date	:	01/07/2007
Last Update Date	:	08/22/2020

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Directions to “PAUL J DIVINCENZO PH.D ” Practice Location

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