Provider Demographics
NPI:1639565450
Name:RESH DAVINIC, ROBYN (PHD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:RESH DAVINIC
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 1:22566 FOREST RUN DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6937
Mailing Address - Country:US
Mailing Address - Phone:908-304-3242
Mailing Address - Fax:
Practice Address - Street 1:22566 FOREST RUN DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-6937
Practice Address - Country:US
Practice Address - Phone:908-304-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004430103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist