Provider Demographics
NPI:1447933411
Name:MATOVU, DIANA EDITH (RBT)
Entity type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:EDITH
Last Name:MATOVU
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SPINET RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3512
Mailing Address - Country:US
Mailing Address - Phone:302-803-2895
Mailing Address - Fax:
Practice Address - Street 1:6 SPINET RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3512
Practice Address - Country:US
Practice Address - Phone:302-803-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DERBT-21-181135106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician