Provider Demographics
NPI:1225148323
Name:DIDIO, DARYL P (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:P
Last Name:DIDIO
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 1:5225 46 ROUTE 347
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-928-4635
Mailing Address - Fax:631-928-4784
Practice Address - Street 1:5225 46 ROUTE 347
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-4635
Practice Address - Fax:631-928-4784
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS005285103TC0700X
FLPY4814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7333181002OtherGHI
S052852BOtherWORKERS COMP
NY00647567Medicaid
7333181002OtherGHI
S052852BOtherWORKERS COMP