1013155027 NPI number — DR. DANIELLE L. DIVELY PSY. D

Table of content: DR. DANIELLE L. DIVELY PSY. D (NPI 1013155027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013155027 NPI number — DR. DANIELLE L. DIVELY PSY. D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIVELY
Provider First Name:
DANIELLE
Provider Middle Name:
L.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY. D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEIGHTY
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY. D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013155027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7564 WOODBURY PIKE (PO BOX 155)
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROARING SPRING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-729-7316
Provider Business Mailing Address Fax Number:
814-729-7538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7564 WOODBURY PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROARING SPRING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-729-7316
Provider Business Practice Location Address Fax Number:
814-729-7538
Provider Enumeration Date:
01/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS016634 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PS016634PA , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PS016634 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023128880002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023128880003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002106964 . This is a "HIGHMARK BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000285381 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102312888 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164856RGD . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023128880004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007708200003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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