Provider Demographics
NPI:1386643922
Name:DEVENIS, LUANNA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUANNA
Middle Name:E
Last Name:DEVENIS
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 1:76 BEDFORD ST
Mailing Address - Street 2:SUITE 34
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4646
Mailing Address - Country:US
Mailing Address - Phone:781-538-5046
Mailing Address - Fax:
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 34
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-538-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7028103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP95566Medicare UPIN
MAW51152Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID