Provider Demographics
NPI:1518328004
Name:DELIUS DYER, WIDMIE (MA)
Entity Type:Individual
Prefix:
First Name:WIDMIE
Middle Name:
Last Name:DELIUS DYER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:WIDMIE
Other - Middle Name:
Other - Last Name:DELIUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1226 E MURIEL ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4109
Mailing Address - Country:US
Mailing Address - Phone:407-900-9574
Mailing Address - Fax:
Practice Address - Street 1:1226 E MURIEL ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4109
Practice Address - Country:US
Practice Address - Phone:407-900-9574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst