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General NPI Number Information
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NPI Number | 1144578758
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Entity Type | Individual
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Provider Name | DIANA CUELLO PH.D
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 480 PIERCE ST SUITE 305
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City | KINGSTON
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State | PA
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Zip | 18704-5512
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Country | US
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Telephone | 570-437-0558
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Fax | 570-714-9444
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Provider Business Mailing Address
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Address Line | 480 PIERCE ST SUITE 305
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City | KINGSTON
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State | PA
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Zip | 18704-5512
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Country | US
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Telephone | 570-437-0558
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Fax | 570-714-9444
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017248
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License Number State | PA
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