Provider Demographics
NPI:1144578758
Name:CUELLO, DIANA (PHD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CUELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 PIERCE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5512
Mailing Address - Country:US
Mailing Address - Phone:570-437-0558
Mailing Address - Fax:570-714-9444
Practice Address - Street 1:480 PIERCE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5512
Practice Address - Country:US
Practice Address - Phone:570-437-0558
Practice Address - Fax:570-714-9444
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical