Provider Demographics
NPI:1609110691
Name:DMS PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:DMS PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO-SUROVCIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-851-3486
Mailing Address - Street 1:42 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1743
Mailing Address - Country:US
Mailing Address - Phone:484-851-3486
Mailing Address - Fax:484-851-3358
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1743
Practice Address - Country:US
Practice Address - Phone:484-851-3486
Practice Address - Fax:484-851-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009188L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA261089OtherPTAN