MEDICARE: DR. LUANNA E DEVENIS 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	103TC1900X	Counseling Psychologist	7028	MA

General Provider Information

NPI Number	:	1386643922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUANNA E DEVENIS PH.D.

Provider Business Mailing Address
First Line	:	76 BEDFORD ST
Second Line	:	SUITE 34
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4646
Country	:	US
Telephone Number	:	781-538-5046
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 BEDFORD ST
Second Line	:	SUITE 34
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4646
Country	:	US
Telephone Number	:	781-538-5046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	02/01/2013

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