Provider Demographics
NPI:1821490798
Name:DECAPRIO, DIANE (EDS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DECAPRIO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-4598
Mailing Address - Country:US
Mailing Address - Phone:216-631-2760
Mailing Address - Fax:
Practice Address - Street 1:5550 CLARK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-4598
Practice Address - Country:US
Practice Address - Phone:216-631-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHKU1040255103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool