Provider Demographics
NPI:1467619585
Name:DIGREGORIO, DANIELLE T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:T
Last Name:DIGREGORIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CLAYBURGH RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19373-1103
Mailing Address - Country:US
Mailing Address - Phone:610-299-0192
Mailing Address - Fax:610-399-1688
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:UPD#1800
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-6843
Practice Address - Fax:856-566-6419
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016425103G00000X, 103T00000X
NJ121-007103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131958Medicare UPIN