Provider Demographics
NPI:1467683532
Name:PUNALES MOREJON, DIANA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:PUNALES MOREJON
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 1:635 WEST 165TH STREET
Mailing Address - Street 2:ROOM 630
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-5977
Mailing Address - Fax:212-305-8394
Practice Address - Street 1:635 WEST 165TH STREET
Practice Address - Street 2:ROOM 630
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017710103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist