DR MICHAEL DIVAK PSYCHOLOGIST NPI 1679054167

NPI Information

NPI: 1679054167
Provider Name: DR MICHAEL DIVAK PSYCHOLOGIST
Classification: Psychologist - 103TC0700X
Specialization: Clinical
Entity Type: Organization
Doing Business As: DR MICHAEL DIVAK PSYCHOLOGIST
Address: 66 MONTGOMERY ST STE 2
CANAJOHARIE, NY
ZIP 13317
Phone: (518) 673-6001

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NPI Details

DR MICHAEL DIVAK PSYCHOLOGIST is a clinical psychologist in Canajoharie, NY. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. DR MICHAEL DIVAK PSYCHOLOGIST NPI is 1679054167. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dr Michael Divak Psychologist.

The provider's business location address is:

66 MONTGOMERY ST STE 2
CANAJOHARIE, NY
ZIP 13317-212
Phone: (518) 673-6001

The provider's authorized official is Michael Norman Divak .
The authorized official title is Sole Proprietor and has the following contact phone number (518) 673-6001.

The enumeration date for this NPI number is 8/23/2018 and was last updated on 8/23/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TC0700X	Psychologist	Clinical	021046-1	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	04054899	MEDICAID	NEW YORK
2	846977	OTHER	VIRGINIA	BEACON HEALTH OPTIONS, INC
3	PRC200309433	OTHER	NEW YORK	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN
4	021046	OTHER	NEW YORK	NEW YORK STATE OFFICE OF THE PROFESSIONS. LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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