Provider Demographics
NPI:1467683532
Name:PUNALES MOREJON, DIANA L (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:PUNALES MOREJON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5715
Mailing Address - Country:US
Mailing Address - Phone:201-255-7985
Mailing Address - Fax:201-621-4467
Practice Address - Street 1:380 MOUNTAIN RD APT 912
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-7306
Practice Address - Country:US
Practice Address - Phone:201-725-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017710103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist