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General NPI Number Information
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NPI Number | 1760876460
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Entity Type | Individual
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Provider Name | DIANNE MARIE AGUERO-TROTTER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 400 SOUTH ORANGE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079
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Country | US
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Telephone | 973-761-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 43 FAIRFIELD AVENUE
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City | CRANFORD
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State | NJ
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Zip | 07016
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Country | US
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Telephone | 908-377-4813
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Fax |
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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 | 35SI00464000
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License Number State | NJ
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