Provider Demographics
NPI:1982079760
Name:DEDILECTIS, MEREDITH (PSYD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:DEDILECTIS
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 1:466 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1462
Mailing Address - Country:US
Mailing Address - Phone:973-370-9944
Mailing Address - Fax:
Practice Address - Street 1:466 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1462
Practice Address - Country:US
Practice Address - Phone:973-370-9944
Practice Address - Fax:973-813-7065
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-05
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00752300103TC0700X, 103TF0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic