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NPI Code Detail

MEDICARE: DR. DIANA C. DIREITER PH.D.

MEDICARE: DR. DIANA C. DIREITER PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist7200MA

General Provider Information

NPI Number : 1598870172
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA C. DIREITER PH.D.
Provider Business Mailing Address
First Line : 36 WESTON AVE
Second Line :
City : QUINCY
State : MA
Zip : 02170-1833
Country : US
Telephone Number : 617-786-0137
Fax Number :
Provider Business Practice Location Address
First Line : 36 WESTON AVE
Second Line :
City : QUINCY
State : MA
Zip : 02170-1833
Country : US
Telephone Number : 617-786-0137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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