Provider Demographics
NPI:1699781898
Name:DEVITO, DIANA V (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:V
Last Name:DEVITO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 ROUTE 23 N
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2002
Mailing Address - Country:US
Mailing Address - Phone:973-492-8700
Mailing Address - Fax:973-492-7670
Practice Address - Street 1:1250 ROUTE 23 N
Practice Address - Street 2:SUITE 5
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-2002
Practice Address - Country:US
Practice Address - Phone:973-492-8700
Practice Address - Fax:973-492-7670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100179100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJIS132OtherOXFORD
NJ6800451OtherGHI
NJ105666OtherMHN
NJ6800451OtherGHI