Provider Demographics
NPI:1003149279
Name:TRICHILO, DIANA LOUISE (PHD, ABPDN)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LOUISE
Last Name:TRICHILO
Suffix:
Gender:F
Credentials:PHD, ABPDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2795
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-2795
Mailing Address - Country:US
Mailing Address - Phone:707-824-1130
Mailing Address - Fax:
Practice Address - Street 1:450 PITT AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3747
Practice Address - Country:US
Practice Address - Phone:707-824-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16784103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist