Active NPI
Jeanne Susan Divincenzo, PSY.D.
- Clinical Psychologist
- Malvern, PA
National Provider Identifier
1962639716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS016886
- Practice address
- 4101 Howell Rd
Malvern, PA 19355-8692 - Phone
- (215) 378-7736
- NPI assigned
- Jun 19, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS016886 | PA | Primary |
Addresses
Primary practice location
4101 Howell Rd
Malvern, PA 19355-8692
Mailing address
4101 Howell Rd
Malvern, PA 19355-8692
Phone (215) 378-7736
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 31, 2025 through Jan 31, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS016886 | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Growth Opportunity Center | 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.
-
- Counseling Psychologist
- Southampton, PA
- NPI 1649222761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738281600000",
"number": "1962639716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4101 HOWELL RD",
"city": "MALVERN",
"state": "PA",
"postal_code": "193558692",
"telephone_number": "215-378-7736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 HOWELL RD",
"city": "MALVERN",
"state": "PA",
"postal_code": "193558692",
"telephone_number": "215-378-7736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIVINCENZO",
"first_name": "JEANNE",
"middle_name": "SUSAN",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-19",
"last_updated": "2025-01-31",
"certification_date": "2025-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS016886",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malvern, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.