Healthcare Provider Details

I. General information

NPI: 1942221858
Provider Name (Legal Business Name): SEAN CONWAY MCDEVITT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 NORTH 16TH STREET A120
PHOENIX AZ
85020
US

IV. Provider business mailing address

7330 NORTH 16TH STREET A120
PHOENIX AZ
85020
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-6635
  • Fax: 602-997-6642
Mailing address:
  • Phone: 602-997-6635
  • Fax: 602-997-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number842
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: