Provider Demographics
NPI:1093713844
Name:DIELMAN, MARC BOYER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:BOYER
Last Name:DIELMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 MONROE ST
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2731
Mailing Address - Country:US
Mailing Address - Phone:419-885-5952
Mailing Address - Fax:419-885-7630
Practice Address - Street 1:5600 MONROE ST
Practice Address - Street 2:SUITE 103B
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2731
Practice Address - Country:US
Practice Address - Phone:419-885-5952
Practice Address - Fax:419-885-7630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3996103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist