Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 53560 | DE |
NPI | 1063798494 |
---|---|
Provider Name | Gregg E Drevno |
First Address | Dover, DE 19904-3401 |
Second Address | Dover, DE 19904-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 31/10/2011 |