Provider Demographics
NPI:1942358148
Name:PAUL J DIVINCENZO PH.D
Entity Type:Organization
Organization Name:PAUL J DIVINCENZO PH.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DIVINCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-518-3900
Mailing Address - Street 1:5311 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5311 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1135
Practice Address - Country:US
Practice Address - Phone:216-518-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3923103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3923OtherUNITED HEALTH CARE
OH000000141048OtherANTHEM
OH0443756Medicaid
OH3923OtherKAISER
OH3923OtherEMERALD HEALTH
OH4073101OtherAETNA
OH3923OtherTRI CARE
OH3923OtherVALUE OPTION
OH288460455007OtherMEDICAL MUTUAL
OH3923OtherMBHS
OH3923OtherCOMPSYCH
OH3923OtherCIGNA
OH3923OtherUNITED BEHAVIORAL HEALTH
OH3923OtherCIGNA