| Doctor Name: | DR. ADOLPH OTTO DI LORETO |
| NPI Number: | 1437121381 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 0822 |
| Business Practice Address: | 352 Blue Star Hwy Blue Star Professional Bldg South Haven, MI - 490907102 |
| Business Phone Number: | 2696371170 |
| Business Fax Number: | 2696391312 |
| Mailing Address: | 352 Blue Star Hwy, Blue Star Professional Bldg SOUTH HAVEN |
| State: | MI |
| Postal Code: | 490907102 |
| Phone Number: | 2696371170 |
| Fax Number: | 2696391312 |
| NPI Enumeration Date: | 02/05/2006 |
| NPI Last Update Date: | 09/06/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0822 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |