Active NPI
Diana Louise Trichilo, PH.D., ABPDN
- Clinical Neuropsychologist
- Sebastopol, CA
National Provider Identifier
1003149279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PSY 16784
- Practice address
- 450 Pitt Ave
Suite 3
Sebastopol, CA 95472-3747 - Phone
- (707) 824-1130
- NPI assigned
- Sep 4, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 16784 | CA | |
| Clinical Neuropsychologist | 103G00000X | PSY 16784 | CA | Primary |
Addresses
Primary practice location
450 Pitt Ave
Suite 3
Sebastopol, CA 95472-3747
Mailing address
PO Box 2795
Sebastopol, CA 95473-2795
Phone (707) 824-1130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 16784 | CA | MD | Psychologist |
| 16784 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488758400000",
"number": "1003149279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2795",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954732795",
"telephone_number": "707-824-1130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 PITT AVE",
"address_2": "SUITE 3",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "954723747",
"telephone_number": "707-824-1130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRICHILO",
"first_name": "DIANA",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "PH.D., ABPDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-04",
"last_updated": "2017-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 16784",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY 16784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sebastopol, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.