Michael Norman Divak, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021046-1 Issued in NY

Practice address

66 Montgomery St Ste 2
Canajoharie, NY 13317-1212

Phone

(518) 673-6001

Fax

(518) 673-6033

NPI assigned

Apr 3, 2014

Last updated

Aug 22, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Michael N. Divak Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr Michael Divak Psychologist

  • Clinical Psychologist
  • Canajoharie, NY
  • NPI 1679054167
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1508284704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 MONTGOMERY ST STE 2",
            "city": "CANAJOHARIE",
            "state": "NY",
            "postal_code": "133171212",
            "telephone_number": "518-673-6001",
            "fax_number": "518-673-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 MONTGOMERY ST STE 2",
            "city": "CANAJOHARIE",
            "state": "NY",
            "postal_code": "133171212",
            "telephone_number": "518-673-6001",
            "fax_number": "518-673-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVAK",
        "first_name": "MICHAEL",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-03",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021046-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE OFFICE OF PROFESSION",
            "identifier": "021046",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE PSYCHOLGIST",
            "identifier": "021046",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "DIVAK",
            "middle_name": "N.",
            "credential": "PSYCHOLOGIST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carol a Balfe, OD, PC (mohawk valley eyecare)
• Karen Marie Caruso, FNP-C
• Lawrence Civil
• Paul Gerald Comber, M.D.
• Denise Derosier
• Alicia Anne Downs, REGISTERED NURSE
• Dr Michael Divak Psychologist
• DW Voght Inc (The Village Apothecary)
• Darlene A Euler, DC
• Amanda Beth Haig

• Clinical Psychologist in Canajoharie, NY
• Providers in Canajoharie, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.