MEDICARE: DR. NADINE REVHEIM 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	103T00000X	Psychologist	014884-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	289774	OTHER	NY	MHN
2	487209	OTHER	NY	VALUE OPTIONS MHS
3	0002353284002	OTHER	NY	UBH
4	P2818996	OTHER	NY	OXFORD
5	2140114	OTHER	NY	CIGNA

General Provider Information

NPI Number	:	1801965405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADINE REVHEIM PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 294
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-0294
Country	:	US
Telephone Number	:	845-358-6410
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 SQUADRON BLVD
Second Line	:	SUITE 318
City	:	NEW CITY
State	:	NY
Zip	:	10956-5214
Country	:	US
Telephone Number	:	845-353-3986
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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