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General NPI Number Information
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NPI Number | 1548258817
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Entity Type | Individual
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Provider Name | DINA VIVIAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 1239 ROUTE 25A SUITE 6A
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City | STONY BROOK
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State | NY
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Zip | 11790-1934
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Country | US
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Telephone | 631-689-3483
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Fax | 631-584-5261
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Provider Business Mailing Address
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Address Line | PO BOX 696
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City | SAINT JAMES
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State | NY
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Zip | 11780-0696
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Country | US
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Telephone | 631-584-5261
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Fax | 631-584-5261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 009593
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 009593
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License Number State | NY
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