Provider Demographics
NPI:1770529893
Name:JAYSON, DIANE F (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:F
Last Name:JAYSON
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 1:14520 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2370
Mailing Address - Country:US
Mailing Address - Phone:301-460-1675
Mailing Address - Fax:301-460-6766
Practice Address - Street 1:14520 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2370
Practice Address - Country:US
Practice Address - Phone:301-460-1675
Practice Address - Fax:301-460-6766
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02466103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR24097Medicare UPIN
MD626176Medicare ID - Type Unspecified