Provider Demographics
NPI:1215540703
Name:DERUYTER, DIANE (LMHC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DERUYTER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 EAST AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2615
Mailing Address - Country:US
Mailing Address - Phone:585-434-2633
Mailing Address - Fax:585-434-2635
Practice Address - Street 1:339 EAST AVE STE 303
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2615
Practice Address - Country:US
Practice Address - Phone:585-434-2633
Practice Address - Fax:585-434-2635
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012871-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health