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General NPI Number Information
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NPI Number | 1689770505
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Entity Type | Individual
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Provider Name | THERESA RUTH DISERIO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 3831 ATTUCKS DR STE B
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City | POWELL
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State | OH
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Zip | 43065-6082
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Country | US
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Telephone | 614-791-0799
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Fax | 614-791-0798
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Provider Business Mailing Address
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Address Line | 3831 ATTUCKS DR SUITE B
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City | POWELL
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State | OH
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Zip | 43065-6082
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Country | US
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Telephone | 614-791-0799
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Fax | 614-791-0798
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4337
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License Number State | OH
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