Provider Demographics
NPI:1598998783
Name:DEBLASE, DIANE BARBARA (APN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:BARBARA
Last Name:DEBLASE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DESCHLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312
Mailing Address - Country:US
Mailing Address - Phone:856-442-0599
Mailing Address - Fax:
Practice Address - Street 1:765 E. ROUTE 70 BLDG A
Practice Address - Street 2:CENTER FOR FAMILY GUIDANCE, PC
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-983-3900
Practice Address - Fax:856-810-0110
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00235300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health