Provider Demographics
NPI:1629753645
Name:MCDIVITT, ADAM (MS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MCDIVITT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15438-1032
Mailing Address - Country:US
Mailing Address - Phone:724-984-1873
Mailing Address - Fax:
Practice Address - Street 1:3055 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3279
Practice Address - Country:US
Practice Address - Phone:724-260-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional