Provider Demographics
NPI:1619436987
Name:ALTIDOR, DARLINE A
Entity Type:Individual
Prefix:
First Name:DARLINE
Middle Name:A
Last Name:ALTIDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 BOWER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-2539
Mailing Address - Country:US
Mailing Address - Phone:908-531-2050
Mailing Address - Fax:
Practice Address - Street 1:810 BOWER ST APT 2
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-2539
Practice Address - Country:US
Practice Address - Phone:908-531-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst