Provider Demographics
NPI:1952524019
Name:DICANIO, PAULA T (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:T
Last Name:DICANIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1265
Mailing Address - Country:US
Mailing Address - Phone:847-604-9441
Mailing Address - Fax:847-604-9445
Practice Address - Street 1:2213 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1265
Practice Address - Country:US
Practice Address - Phone:847-604-9441
Practice Address - Fax:847-604-9445
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical