Provider Demographics
NPI:1174648679
Name:DEVINE, ROBERTA H (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:H
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 4TH AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2370
Mailing Address - Country:US
Mailing Address - Phone:206-378-0599
Mailing Address - Fax:
Practice Address - Street 1:2568 4TH AVE W STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2370
Practice Address - Country:US
Practice Address - Phone:206-378-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001516103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27005Medicare ID - Type Unspecified