Provider Demographics
NPI:1982318515
Name:DISPOTO, AIMEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:
Last Name:DISPOTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3237
Mailing Address - Country:US
Mailing Address - Phone:305-401-6987
Mailing Address - Fax:
Practice Address - Street 1:57 W 57TH ST STE 912
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2829
Practice Address - Country:US
Practice Address - Phone:305-401-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100525400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical