Healthcare Provider Details

I. General information

NPI: 1760306765
Provider Name (Legal Business Name): DIANE BARRETT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HICKORY RIDGE CT
MULLICA HILL NJ
08062-4636
US

IV. Provider business mailing address

17 HICKORY RIDGE CT
MULLICA HILL NJ
08062-4636
US

V. Phone/Fax

Practice location:
  • Phone: 215-292-6823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00819600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS017438
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: