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NPI 1982079760

NPI 1982079760 : MEREDITH DEDILECTIS PSYD : CHATHAM, NJ

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General NPI Number Information
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    NPI Number           |    1982079760
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    Entity Type          |    Individual 
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    Provider Name        |    MEREDITH DEDILECTIS PSYD
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    12/05/2015
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    Last Update Date     |    03/13/2025
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Provider Practice Location Address
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    Address Line         |    466 SOUTHERN BLVD 
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    City                 |    CHATHAM
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    State                |    NJ
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    Zip                  |    07928-1462
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    Country              |    US
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    Telephone            |    973-370-9944
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    Fax                  |    973-813-7065
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Provider Business Mailing Address
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    Address Line         |    466 SOUTHERN BLVD 
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    City                 |    CHATHAM
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    State                |    NJ
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    Zip                  |    07928-1462
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    Country              |    US
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    Telephone            |    973-370-9944
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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       |    35SI00752300
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    License Number State |    NJ
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Taxonomy #2
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    Taxonomy Code        |    103TF0200X
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    Taxonomy Name        |    Forensic Psychologist
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    License Number       |    35SI00752300
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    License Number State |    NJ
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Taxonomy #3
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    Taxonomy Code        |    103TC2200X
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    Taxonomy Name        |    Clinical Child & Adolescent Psychologist
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    License Number       |    35SI00752300
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    License Number State |    NJ
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