Healthcare Provider Details

I. General information

NPI: 1609110691
Provider Name (Legal Business Name): DIANNE MARINO SUROVCIK PHD DBA DMS PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W BUTTERNUT RD
HELLERTOWN PA
18055-9712
US

IV. Provider business mailing address

175 W BUTTERNUT RD
HELLERTOWN PA
18055-9712
US

V. Phone/Fax

Practice location:
  • Phone: 484-851-3486
  • Fax:
Mailing address:
  • Phone: 484-851-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DIANNE MARINO-SUROVCIK PHD
Title or Position: OWNER
Credential: PHD
Phone: 484-851-3486