Active NPI
Andrew Joseph Disavino, PSY.D.
- Clinical Psychologist
- Las Vegas, NV
National Provider Identifier
1962593806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS-006371-L
- Practice address
- 916 W Owens Ave
Las Vegas, NV 89106-2516 - Phone
- (702) 636-4060
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS-006371-L | PA | Primary |
Addresses
Primary practice location
916 W Owens Ave
Las Vegas, NV 89106-2516
Mailing address
6500 Vegas Dr
2089
Las Vegas, NV 89108-7707
Phone (215) 892-8956
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS-006371-L | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Services Group | Clinical | 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.
-
- Clinical Psychologist
- Ambler, PA
- NPI 1255459848
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1962593806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6500 VEGAS DR",
"address_2": "2089",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891087707",
"telephone_number": "215-892-8956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "916 W OWENS AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891062516",
"telephone_number": "702-636-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISAVINO",
"first_name": "ANDREW",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS-006371-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.