Basic Information
Provider Information
NPI: 1003149279
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRICHILO
FirstName: DIANA
MiddleName: LOUISE
NamePrefix: DR.
NameSuffix:  
Credential: PH.D., ABPDN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2795
Address2:  
City: SEBASTOPOL
State: CA
PostalCode: 954732795
CountryCode: US
TelephoneNumber: 7078241130
FaxNumber:  
Practice Location
Address1: 450 PITT AVE
Address2: SUITE 3
City: SEBASTOPOL
State: CA
PostalCode: 954723747
CountryCode: US
TelephoneNumber: 7078241130
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/04/2009
LastUpdateDate: 03/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103G00000XPSY 16784CAY Behavioral Health & Social Service ProvidersClinical Neuropsychologist 
103T00000XPSY 16784CAN Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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