Michael Joseph Redivo, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

3433 Issued in AZ

Practice address

4229 N 16TH St
Phoenix, AZ 85016-5318

Phone

(602) 277-4482

Fax

(602) 277-4483

NPI assigned

Oct 29, 2008

Last updated

Oct 29, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225238400000",
    "number": "1790938157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4229 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165318",
            "telephone_number": "602-277-4482",
            "fax_number": "602-277-4483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4229 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165318",
            "telephone_number": "602-277-4482",
            "fax_number": "602-277-4483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDIVO",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-29",
        "last_updated": "2008-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "AZ",
            "license": "3433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Child & Adolescent Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; 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.