Provider Demographics
NPI:1982668570
Name:MARINO-SUROVCIK, DIANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:
Last Name:MARINO-SUROVCIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DMS PSYCHOLOGICAL
Other - Middle Name:SERVICES
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:175 W BUTTERNUT RD
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-9712
Mailing Address - Country:US
Mailing Address - Phone:610-762-1949
Mailing Address - Fax:484-851-3358
Practice Address - Street 1:3477 CORPORATE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8237
Practice Address - Country:US
Practice Address - Phone:610-762-1949
Practice Address - Fax:484-851-3358
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009188L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA261089Medicare UPIN