Provider Demographics
NPI:1336839687
Name:PANISH, DEVORA (PSYD)
Entity type:Individual
Prefix:
First Name:DEVORA
Middle Name:
Last Name:PANISH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DEVORA
Other - Middle Name:
Other - Last Name:SCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:258 S ADELAIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:258 S ADELAIDE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1654
Practice Address - Country:US
Practice Address - Phone:732-743-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6845103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist