Individual
MR. DAVID JAMES DERITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
215 W LAKE SHORE DR, TOWER LAKES, IL 60010-1130
(847) 526-6557
Mailing address
215 W LAKE SHORE DR, TOWER LAKES, IL 60010-1130
(847) 526-6557
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-002434
IL
Other
Enumeration date
05/29/2009
Last updated
05/29/2009
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