Provider Demographics
NPI:1417372103
Name:NEVEDAL, DANA CATHARINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:CATHARINE
Last Name:NEVEDAL
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 1:435 NEW KARNER RD
Mailing Address - Street 2:NORTHEAST PSYCHOLOGICAL ASSOCIATES
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3833
Mailing Address - Country:US
Mailing Address - Phone:518-456-2060
Mailing Address - Fax:518-456-2361
Practice Address - Street 1:435 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3833
Practice Address - Country:US
Practice Address - Phone:518-456-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020430103TB0200X, 103TC0700X, 103TH0004X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation