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General NPI Number Information
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NPI Number | 1811232895
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Entity Type | Individual
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Provider Name | ELISE GINA DEVECCHIO-CAVAGNARO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 26501 AVENUE 140
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City | PORTERVILLE
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State | CA
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Zip | 93257-9109
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Country | US
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Telephone | 559-782-2855
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 9TH ST ROOM 205 MAIN STOP: 2-3
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City | SACRAMENTO
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State | CA
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Zip | 95814-6414
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Country | US
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Telephone |
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Fax |
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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 | PSY 12606
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License Number State | CA
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