Provider Demographics
NPI:1952692865
Name:THOMAS DILORETO PHD INC
Entity Type:Organization
Organization Name:THOMAS DILORETO PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DILORETO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-264-3014
Mailing Address - Street 1:1409 KINGSLEY AVE
Mailing Address - Street 2:#9C
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4537
Mailing Address - Country:US
Mailing Address - Phone:904-264-3014
Mailing Address - Fax:904-269-0842
Practice Address - Street 1:1409 KINGSLEY AVE
Practice Address - Street 2:#9C
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4537
Practice Address - Country:US
Practice Address - Phone:904-264-3014
Practice Address - Fax:904-269-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZSW9901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty