Provider Demographics
NPI:1619204740
Name:MENAGO, DIANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MENAGO
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 1:213 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1514
Mailing Address - Country:US
Mailing Address - Phone:215-579-0302
Mailing Address - Fax:215-579-0305
Practice Address - Street 1:213 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1514
Practice Address - Country:US
Practice Address - Phone:215-579-0302
Practice Address - Fax:215-579-0305
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016705103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist