Provider Demographics
NPI:1073682985
Name:NEVO, DINA (PSYD LCSW BCD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:NEVO
Suffix:
Gender:F
Credentials:PSYD LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CONSHOHOCKEN AVE
Mailing Address - Street 2:S C-6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5363
Mailing Address - Country:US
Mailing Address - Phone:215-877-3024
Mailing Address - Fax:215-877-7486
Practice Address - Street 1:3600 CONSHOHOCKEN AVE
Practice Address - Street 2:S C-6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-5363
Practice Address - Country:US
Practice Address - Phone:215-877-3024
Practice Address - Fax:215-877-7486
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PACWO139951041C0700X
PA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001659328 0004Medicaid
PA126655OtherVALUE OPTION A871444
PA1663278OtherPERSONAL CHOICE
PA001659328 0004Medicaid
PAS15604Medicare UPIN