Individual
DR. MARTIN JOSEPH DE VITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-2603
(315) 783-8792
Mailing address
11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-2603
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810007818
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/02/2020
Last updated
07/29/2024
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