Provider Demographics
NPI:1598408270
Name:DITMAR, FLORENCE M (PHD)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:M
Last Name:DITMAR
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 1:11 SABLE CT
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-3356
Mailing Address - Country:US
Mailing Address - Phone:109-549-6565
Mailing Address - Fax:
Practice Address - Street 1:11 SABLE CT
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-3356
Practice Address - Country:US
Practice Address - Phone:609-549-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical