Provider Demographics
NPI:1285864975
Name:DIETZ, LAURA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:DIETZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 OHARA ST
Mailing Address - Street 2:BELLEFIELD TOWERS 309
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2593
Mailing Address - Country:US
Mailing Address - Phone:412-246-5632
Mailing Address - Fax:
Practice Address - Street 1:3811 OHARA ST
Practice Address - Street 2:BELLEFIELD TOWERS 309
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2593
Practice Address - Country:US
Practice Address - Phone:412-246-5632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016613103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent