Provider Demographics
NPI:1568741668
Name:DILAZZERO, DEBORAH B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:B
Last Name:DILAZZERO
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 1:100 S BROAD ST
Mailing Address - Street 2:SUITE 1215
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1023
Mailing Address - Country:US
Mailing Address - Phone:484-629-8581
Mailing Address - Fax:
Practice Address - Street 1:100 S BROAD ST
Practice Address - Street 2:SUITE 1215
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1023
Practice Address - Country:US
Practice Address - Phone:484-629-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical