Individual
DR. DINA VIVIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1239 ROUTE 25A, SUITE 6A, STONY BROOK, NY 11790-1934
(631) 689-3483
(631) 584-5261
Mailing address
PO BOX 696, SAINT JAMES, NY 11780-0696
(631) 584-5261
(631) 584-5261
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
009593
NY
103TC0700X
Clinical Psychologist
Primary
009593
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0038569
GHI
NY
01
—
069201
VALUE OPTIONS
NM
01
—
085652000
MAGELLAN BEHAVIORAL HEALT
NY
01
—
P590784
OXFORD HEALTH INSURANCE
NY
Enumeration date
10/11/2005
Last updated
11/28/2011
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