Provider Demographics
NPI:1811963838
Name:DEVINNEY, SHARON E (PHD, HSPP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:DEVINNEY
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 13L, PO BOX 52
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-0052
Mailing Address - Country:US
Mailing Address - Phone:574-286-0055
Mailing Address - Fax:574-243-8014
Practice Address - Street 1:6910 NORTH MAIN STREET
Practice Address - Street 2:BUILDING 13, SUITE 13L
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-286-0055
Practice Address - Fax:574-243-8011
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040792103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200008740AMedicaid
IN237590CMedicare ID - Type Unspecified
IN200008740AMedicaid