Diamond Valley Behaviroal LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

DIAMOND VALLEY BEHAVIROAL LLC

Practice address

427 High St
Burlington, NJ 08016-4587

Phone

(609) 587-0113

Fax

(609) 388-6325

NPI assigned

May 16, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alice L Kalu, PMHNP-BC

Title

Apn

Phone

(609) 587-0113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diamond Valley behaviroal llc Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652659200000",
    "number": "1801533443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 HIGH ST UNIT 1823",
            "city": "BURLINGTON",
            "state": "NJ",
            "postal_code": "080164585",
            "telephone_number": "609-587-0113",
            "fax_number": "609-388-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 HIGH ST",
            "city": "BURLINGTON",
            "state": "NJ",
            "postal_code": "080164587",
            "telephone_number": "609-587-0113",
            "fax_number": "609-388-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMOND VALLEY BEHAVIROAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A",
        "authorized_official_last_name": "KALU",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "APN",
        "authorized_official_telephone_number": "609-587-0113",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245870658",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "diamondvalleybhnj@outlook.com",
            "affiliation": "N",
            "address_1": "427 High St Unit 1823",
            "city": "Burlington",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080164585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Diamond Valley behaviroal llc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mamio Christa Detullio, DC
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• Robert John Dixon Jr.
• Laura Dizpenza, LPN

• Psychiatry Physician in Burlington, NJ
• Providers in Burlington, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.