Provider Demographics
NPI:1619496759
Name:DIDY-DUME, ELMIRE VANESSA
Entity Type:Individual
Prefix:
First Name:ELMIRE
Middle Name:VANESSA
Last Name:DIDY-DUME
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 1:148 LONDON DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4621
Mailing Address - Country:US
Mailing Address - Phone:347-589-4799
Mailing Address - Fax:
Practice Address - Street 1:10514 RACETRACK RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3241
Practice Address - Country:US
Practice Address - Phone:410-973-2371
Practice Address - Fax:410-973-2305
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty