MEDICARE: DR. DORIS EILEEN NEVIN 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	1431	NM
2	103TC1900X	Counseling Psychologist	0810000245	VA
3	103TF0200X	Forensic Psychologist	0810000245	VA
4	103TP0016X	Prescribing (Medical) Psychologist	PSY-RXP0058	NM
5	103TP0016X	Prescribing (Medical) Psychologist	321261	LA

General Provider Information

NPI Number	:	1902017114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORIS EILEEN NEVIN PH.D.

Provider Business Mailing Address
First Line	:	305 LIVE OAK DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3903
Country	:	US
Telephone Number	:	540-354-6174
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 W PINHOOK RD STE 303
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3735
Country	:	US
Telephone Number	:	337-534-4214
Fax Number	:	337-484-1405

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

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	11/15/2022

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