Provider Demographics
NPI:1700085792
Name:PRIGNANO, JOHN VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VINCENT
Last Name:PRIGNANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:VINCENT
Other - Last Name:PRIGNANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:635 NW COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3257
Mailing Address - Country:US
Mailing Address - Phone:541-388-8233
Mailing Address - Fax:541-383-2993
Practice Address - Street 1:635 NW COLORADO AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3257
Practice Address - Country:US
Practice Address - Phone:541-388-8233
Practice Address - Fax:541-383-2993
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical