Healthcare Provider Details

I. General information

NPI: 1144009671
Provider Name (Legal Business Name): DIANNA WAMBACH ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 E BASIN RD
NEW CASTLE DE
19720-4200
US

IV. Provider business mailing address

318 E BASIN RD
NEW CASTLE DE
19720-4200
US

V. Phone/Fax

Practice location:
  • Phone: 302-323-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number255264
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: