Provider Demographics
NPI:1396042248
Name:DIPISA, JAMES J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:DIPISA
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 1:295 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5125
Mailing Address - Country:US
Mailing Address - Phone:203-257-4350
Mailing Address - Fax:
Practice Address - Street 1:295 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5125
Practice Address - Country:US
Practice Address - Phone:203-257-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical