MEDICARE: DR. DIANA V. DEVITO 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
1	103TC0700X	Clinical Psychologist	35S100179100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IS132	OTHER	NJ	OXFORD
2	6800451	OTHER	NJ	GHI
3	105666	OTHER	NJ	MHN

General Provider Information

NPI Number	:	1699781898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA V. DEVITO PH.D.

Provider Business Mailing Address
First Line	:	1250 ROUTE 23 N
Second Line	:	SUITE 5
City	:	BUTLER
State	:	NJ
Zip	:	07405-2002
Country	:	US
Telephone Number	:	973-492-8700
Fax Number	:	973-492-7670

Provider Business Practice Location Address
First Line	:	1250 ROUTE 23 N
Second Line	:	SUITE 5
City	:	BUTLER
State	:	NJ
Zip	:	07405-2002
Country	:	US
Telephone Number	:	973-492-8700
Fax Number	:	973-492-7670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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