Provider Demographics
NPI:1164597365
Name:DIDIER, GEORGE JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:DIDIER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10783 VALLEY VIEW POINT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-6835
Mailing Address - Country:US
Mailing Address - Phone:815-399-2611
Mailing Address - Fax:815-885-2611
Practice Address - Street 1:6066 STRATHMOOR DR
Practice Address - Street 2:C3
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107
Practice Address - Country:US
Practice Address - Phone:815-399-2611
Practice Address - Fax:815-885-2611
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL378690Medicare ID - Type Unspecified