Dr Michael Divak Psychologist

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021046-1 Issued in NY

Legal business name

DR MICHAEL DIVAK PSYCHOLOGIST

Doing business as

DR MICHAEL DIVAK PSYCHOLOGIST

Practice address

66 Montgomery St Ste 2
Canajoharie, NY 13317-1212

Phone

(518) 673-6001

NPI assigned

Aug 23, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Michael Norman Divak, PHDNPI 1508284704

Title

Sole Proprietor

Phone

(518) 673-6001

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• DR MICHAEL DIVAK PSYCHOLOGIST Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Norman Divak, PH.D.

  • Clinical Psychologist
  • Canajoharie, NY
  • NPI 1508284704
  NPD Authorized official

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534982400000",
    "number": "1679054167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 MONTGOMERY ST",
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MICHAEL DIVAK PSYCHOLOGIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-23",
        "last_updated": "2018-08-23",
        "status": "A",
        "authorized_official_last_name": "DIVAK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "518-673-6001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021046-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH OPTIONS, INC",
            "identifier": "846977",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN",
            "identifier": "PRC200309433",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK  STATE OFFICE OF THE PROFESSIONS.  LICENSE",
            "identifier": "021046",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04054899",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DR MICHAEL DIVAK PSYCHOLOGIST",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DR MICHAEL DIVAK PSYCHOLOGIST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karen Marie Caruso, FNP-C
• Paul Gerald Comber, M.D.
• Denise Derosier
• Michael Norman Divak, PH.D.
• Alicia Anne Downs, REGISTERED NURSE
• DW Voght Inc
• Darlene A Euler, DC
• Amanda Beth Haig
• Brian W Hall, R.P.A.
• Linda C Heiser

• 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 23, 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.