Provider Demographics
NPI:1497537864
Name:KEVELSON, DAVINA (LMHC)
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:
Last Name:KEVELSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3204
Mailing Address - Country:US
Mailing Address - Phone:917-565-7561
Mailing Address - Fax:
Practice Address - Street 1:42 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3204
Practice Address - Country:US
Practice Address - Phone:917-565-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health