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NPI Code Detail

MEDICARE: ROBERT B DEVINNEY PHD

MEDICARE: ROBERT B DEVINNEY PHD
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
1103TC0700XClinical Psychologist012661-1NY
2103G00000XClinical Neuropsychologist
3103TA0400XAddiction (Substance Use Disorder) Psychologist
4103TA0700XAdult Development & Aging Psychologist
5103TR0400XRehabilitation Psychologist

General Provider Information

NPI Number : 1184922056
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT B DEVINNEY PHD
Provider Business Mailing Address
First Line : 414 SUNRISE HWY
Second Line : PMB 329
City : PATCHOGUE
State : NY
Zip : 11772-2254
Country : US
Telephone Number : 631-987-3780
Fax Number : 631-204-0069
Provider Business Practice Location Address
First Line : 105 MEDFORD AVE
Second Line :
City : PATCHOGUE
State : NY
Zip : 11772-1223
Country : US
Telephone Number : 631-987-3780
Fax Number : 631-204-0069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2011
Last Update Date : 03/02/2011

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