Provider Demographics
NPI:1992060560
Name:DICHTER, JOLIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOLIE
Middle Name:
Last Name:DICHTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DIXON AVENUE
Mailing Address - Street 2:COPIAGUE HIGH SCHOOL
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726
Mailing Address - Country:US
Mailing Address - Phone:631-842-4010
Mailing Address - Fax:631-842-4018
Practice Address - Street 1:1100 DIXON AVENUE
Practice Address - Street 2:COPIAGUE HIGH SCHOOL
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726
Practice Address - Country:US
Practice Address - Phone:631-842-4010
Practice Address - Fax:631-842-4018
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013859103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool