Provider Demographics
NPI:1790002616
Name:DIMAGGIO, DEANA ROBERTS (MS LLP)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:ROBERTS
Last Name:DIMAGGIO
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37727 PROFESSIONAL CENTER DR
Mailing Address - Street 2:STE.110
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1195
Mailing Address - Country:US
Mailing Address - Phone:810-599-8857
Mailing Address - Fax:
Practice Address - Street 1:37727 PROFESSIONAL CENTER DR
Practice Address - Street 2:STE.110
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1195
Practice Address - Country:US
Practice Address - Phone:810-599-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical