Provider Demographics
NPI:1265528731
Name:DICHIARO, JOAN (PNP MS CNS)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:DICHIARO
Suffix:
Gender:F
Credentials:PNP MS CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SPICE BUSH LANE
Mailing Address - Street 2:
Mailing Address - City:TUXEDO
Mailing Address - State:NY
Mailing Address - Zip Code:10987
Mailing Address - Country:US
Mailing Address - Phone:845-351-2482
Mailing Address - Fax:
Practice Address - Street 1:3 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-368-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401038-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health