Provider Demographics
NPI:1639286909
Name:DIETER, RONALD PAUL (DMIN)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:PAUL
Last Name:DIETER
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4926
Mailing Address - Country:US
Mailing Address - Phone:603-228-1044
Mailing Address - Fax:603-228-1044
Practice Address - Street 1:18 N MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4926
Practice Address - Country:US
Practice Address - Phone:603-228-1044
Practice Address - Fax:603-228-1044
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH28101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006330Medicaid