Provider Demographics
NPI:1518949163
Name:DIDDEL, ROBERTA MEINHOLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:MEINHOLD
Last Name:DIDDEL
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 1:3754 GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2822
Mailing Address - Country:US
Mailing Address - Phone:713-665-7934
Mailing Address - Fax:713-660-7443
Practice Address - Street 1:3754 GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2822
Practice Address - Country:US
Practice Address - Phone:713-665-7934
Practice Address - Fax:713-660-7443
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24283103T00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G53YMedicare ID - Type Unspecified