Provider Demographics
NPI:1942704176
Name:DICECCA, ELAINE M
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:DICECCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6A DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3646
Mailing Address - Country:US
Mailing Address - Phone:603-986-1295
Mailing Address - Fax:
Practice Address - Street 1:6A DEARBORN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3646
Practice Address - Country:US
Practice Address - Phone:603-986-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor