Provider Demographics
NPI:1376980235
Name:ORETADE-BRANCH, DIERDRA L (DSW, LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:DIERDRA
Middle Name:L
Last Name:ORETADE-BRANCH
Suffix:
Gender:F
Credentials:DSW, LCSW, BCD
Other - Prefix:
Other - First Name:DIERDRA
Other - Middle Name:L
Other - Last Name:ORETADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 THE GRN STE 12921
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 TUSKEGEE BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19902-5003
Practice Address - Country:US
Practice Address - Phone:302-677-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00118591041C0700X
NCC0085391041C0700X
NJNJDCATEMP-0475831041C0700X
NJ44SC060993001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical