Provider Demographics
NPI:1689291007
Name:DITOMASSO, KERIANNE ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERIANNE
Middle Name:ELIZABETH
Last Name:DITOMASSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:KERIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:TITUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1551 BISHOP ST STE A-130
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4635
Mailing Address - Country:US
Mailing Address - Phone:805-246-9234
Mailing Address - Fax:
Practice Address - Street 1:1551 BISHOP ST STE A-130
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-246-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty