Provider Demographics
NPI:1801965405
Name:REVHEIM, NADINE (PHD)
Entity type:Individual
Prefix:DR
First Name:NADINE
Middle Name:
Last Name:REVHEIM
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:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-0294
Mailing Address - Country:US
Mailing Address - Phone:845-358-6410
Mailing Address - Fax:
Practice Address - Street 1:17 SQUADRON BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5214
Practice Address - Country:US
Practice Address - Phone:845-353-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014884-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY289774OtherMHN
NY487209OtherVALUE OPTIONS MHS
NY0002353284002OtherUBH
NYP2818996OtherOXFORD
NY2140114OtherCIGNA
NY289774OtherMHN