Provider Demographics
NPI:1134716533
Name:PRICE, DEATRICE DIANE
Entity type:Individual
Prefix:MISS
First Name:DEATRICE
Middle Name:DIANE
Last Name:PRICE
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 1:21991 LIBBY RD APT 302
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6875
Mailing Address - Country:US
Mailing Address - Phone:216-323-6579
Mailing Address - Fax:
Practice Address - Street 1:21991 LIBBY RD APT 302
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-6875
Practice Address - Country:US
Practice Address - Phone:216-323-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities