Active NPI
Paul John Divincenzo, PH.D
- Psychologist
- Bedford HTS, OH
National Provider Identifier
1386740439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 3923
- Practice address
- 5311 Northfield Rd
Bedford HTS, OH 44146-1135 - Phone
- (216) 518-3900
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 3923 | OH | Primary |
Addresses
Primary practice location
5311 Northfield Rd
Bedford HTS, OH 44146-1135
Mailing address
1019 Hillcreek LN
Gates Mills, OH 44040-9630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0443756 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3923 | OH | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paul J Divincenzo PH.D | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Bedford HTS, OH
- NPI 1942358148
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1386740439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 HILLCREEK LN",
"city": "GATES MILLS",
"state": "OH",
"postal_code": "440409630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5311 NORTHFIELD RD",
"city": "BEDFORD HTS",
"state": "OH",
"postal_code": "441461135",
"telephone_number": "216-518-3900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIVINCENZO",
"first_name": "PAUL",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "3923",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0443756",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bedford HTS, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.