Provider Demographics
NPI:1528118189
Name:DIEPOLD, JOHN H JR (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:DIEPOLD
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E MAIN ST
Mailing Address - Street 2:VICTORIA MEDICAL ARTS, EAST BLDG., 2ND FLOOR
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3082
Mailing Address - Country:US
Mailing Address - Phone:856-778-9300
Mailing Address - Fax:
Practice Address - Street 1:703 E MAIN ST
Practice Address - Street 2:VICTORIA MEDICAL ARTS, EAST BLDG., 2ND FLOOR
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3082
Practice Address - Country:US
Practice Address - Phone:856-778-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100152300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical