=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982833505
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANNA H. CONNER-JEFFERS PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2009
-----------------------------------------------------
Last Update Date | 05/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 MAIN ST. CHELSEA SQUARE UNIT 1
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-464-5445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 542
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-0542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-464-5445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | B1-0001168
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------