Healthcare Provider Details

I. General information

NPI: 1700699618
Provider Name (Legal Business Name): SYLVIA PATRICIA DIMENNA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117-119 ROOSEVELT AVENUE
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

117-119 ROOSEVELT AVENUE
PLAINFIELD NJ
07060
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-5566
  • Fax:
Mailing address:
  • Phone: 908-756-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00945100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: