Provider Demographics
NPI:1831243310
Name:DIETRICH, JEANNE C
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:C
Last Name:DIETRICH
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 1:550 MAMARONECK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1634
Mailing Address - Country:US
Mailing Address - Phone:914-381-6163
Mailing Address - Fax:914-234-1275
Practice Address - Street 1:550 MAMARONECK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1634
Practice Address - Country:US
Practice Address - Phone:914-381-6163
Practice Address - Fax:914-234-1275
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical