Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 001952 | CT |
N | 103T00000X | Psychologist | 001952 | CT |
Y | 102L00000X | Psychologist | PS015026 | PA |
Y | 103T00000X | Psychologist | PS015026 | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 001952 | CT |
N | 103G00000X | Clinical Psychologist | 001952 | CT |
N | 103TC0700X | Clinical Psychologist | 001952 | CT |
N | 103G00000X | Clinical Psychologist | PS015026 | PA |
N | 103TC0700X | Clinical Psychologist | PS015026 | PA |
NPI | 1427299809 |
---|---|
Provider Name | Dr. Dominick Dephilippis |
First Address | Hammonton, NJ 08037-1152 |
Second Address | Hammonton, NJ 08037-1152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2009 |
Last Update Date | 16/03/2009 |