Active NPI
F Victoria Dicicco, PHD
- Clinical Psychologist
- San Diego, CA
National Provider Identifier
1003801457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY7974
- Practice address
- 5190 Governor Dr
Ste 108
San Diego, CA 92122-2847 - Phone
- (858) 452-5800
- Fax
- (858) 546-0411
- NPI assigned
- Sep 13, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY7974 | CA | Primary |
Addresses
Primary practice location
5190 Governor Dr
Ste 108
San Diego, CA 92122-2847
Mailing address
5190 Governor Drive
Ste 108
San Diego, CA 92122
Phone (858) 452-5800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY079740 | Medicaid | CA |
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 |
|---|---|---|---|
| PSY7974 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196899200000",
"number": "1003801457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5190 GOVERNOR DRIVE",
"address_2": "STE 108",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92122",
"telephone_number": "858-452-5800",
"fax_number": "858-546-0411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5190 GOVERNOR DR",
"address_2": "STE 108",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921222847",
"telephone_number": "858-452-5800",
"fax_number": "858-546-0411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICICCO",
"first_name": "F",
"middle_name": "VICTORIA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-13",
"last_updated": "2007-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY7974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY079740",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.