Provider Demographics
NPI:1598870172
Name:DIREITER, DIANA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:C
Last Name:DIREITER
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 1:36 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1833
Mailing Address - Country:US
Mailing Address - Phone:617-786-0137
Mailing Address - Fax:
Practice Address - Street 1:36 WESTON AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-1833
Practice Address - Country:US
Practice Address - Phone:617-786-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50797Medicare ID - Type Unspecified