Provider Demographics
NPI:1679825863
Name:PEREZ-DI VITO, GLADYS (MA IN PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:PEREZ-DI VITO
Suffix:
Gender:F
Credentials:MA IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GRAND ST.
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-636-4440
Mailing Address - Fax:914-220-3315
Practice Address - Street 1:70 GRAND ST.
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-636-4440
Practice Address - Fax:914-220-3315
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health