Provider Demographics
NPI:1083401921
Name:DICATALDO, MARY ELLEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:DICATALDO
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FORDS RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2146
Mailing Address - Country:US
Mailing Address - Phone:973-271-2510
Mailing Address - Fax:
Practice Address - Street 1:466 SOUTHERN BLVD
Practice Address - Street 2:JEFFERSON BUILDING THIRD FLOOR
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928
Practice Address - Country:US
Practice Address - Phone:973-370-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ243-047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist