Provider Demographics
NPI:1740716307
Name:DIVITO, MICHAEL FRANCIS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:DIVITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 REDSTONE DR
Mailing Address - Street 2:PARSIPPANY
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2057
Mailing Address - Country:US
Mailing Address - Phone:908-917-9442
Mailing Address - Fax:
Practice Address - Street 1:86 REDSTONE DR
Practice Address - Street 2:PARSIPPANY
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2057
Practice Address - Country:US
Practice Address - Phone:908-917-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst