Organization
PAUL J DIVINCENZO PH.D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JOHN DIVINCENZO (PRESIDENT)
(216) 518-3900
Entity
Organization
Contact information
Practice address
5311 NORTHFIELD RD, BEDFORD HTS, OH 44146-1135
(216) 518-3900
Mailing address
5311 NORTHFIELD RD, BEDFORD HTS, OH 44146-1135
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3923
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141048
ANTHEM
OH
05
—
0443756
—
OH
01
—
288460455007
MEDICAL MUTUAL
OH
01
—
3923
UNITED HEALTH CARE
OH
01
—
4073101
AETNA
OH
Enumeration date
01/07/2007
Last updated
08/22/2020
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