Individual
DR. MICHAEL NORMAN DIVAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
66 MONTGOMERY ST STE 2, CANAJOHARIE, NY 13317-1212
(518) 673-6001
(518) 673-6033
Mailing address
66 MONTGOMERY ST STE 2, CANAJOHARIE, NY 13317-1212
(518) 673-6001
(518) 673-6033
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
021046-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021046
LICENSE PSYCHOLGIST
NY
Enumeration date
04/03/2014
Last updated
08/22/2018
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