Provider Demographics
NPI:1346021268
Name:DEVOGEL, JEANINE M-O
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:M-O
Last Name:DEVOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8484
Mailing Address - Country:US
Mailing Address - Phone:845-637-5031
Mailing Address - Fax:
Practice Address - Street 1:384 CRYSTAL RUN RD STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4073
Practice Address - Country:US
Practice Address - Phone:845-769-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY380710911103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No171M00000XOther Service ProvidersCase Manager/Care Coordinator