Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | ||
Y | 103TC0700X | Clinical Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103G00000X | Clinical Psychologist | 012661-1 | NY |
N | 103TC0700X | Clinical Psychologist | 012661-1 | NY |
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1184922056 |
---|---|
Provider Name | Robert B Devinney |
First Address | Patchogue, NY 11772-2254 |
Second Address | Patchogue, NY 11772-1223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2011 |
Last Update Date | 02/03/2011 |