Doctor Name: | MICHAEL DIVAK |
NPI Number: | 1508284704 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 021046-1 |
Business Practice Address: | 66 Montgomery St Canajoharie, NY - 133171212 |
Business Phone Number: | 5186738060 |
Business Fax Number: | 5186738061 |
Mailing Address: | 66 Montgomery St, CANAJOHARIE |
State: | NY |
Postal Code: | 133171212 |
Phone Number: | 5186738060 |
Fax Number: | 5186738061 |
NPI Enumeration Date: | 04/03/2014 |
NPI Last Update Date: | 02/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 021046-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |