Provider Demographics
NPI:1659642965
Name:DEVERA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:DEVERA PSYCHOLOGICAL SERVICES
Other - Org Name:AISHA DEVERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-296-5945
Mailing Address - Street 1:555 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2757
Mailing Address - Country:US
Mailing Address - Phone:702-293-5945
Mailing Address - Fax:702-293-5168
Practice Address - Street 1:555 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2757
Practice Address - Country:US
Practice Address - Phone:702-293-5945
Practice Address - Fax:702-293-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0619103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty