Melinda Susan Diciro, PSY.D.
Individual provider Active NPI Clinical Psychologist · Represa, CA
NPI 1043489800 · NPPES record last updated Feb 26, 2008
Key facts
- NPI
- 1043489800
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- CA18482 (CA)
- Practice address
- 100 Prison Rd
Represa, CA 95671-3000 - Phone
- (916) 985-8610
- NPI assigned
- Feb 26, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA18482 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Corrections and Rehabilitation-Headquarters | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | CA18482 | CA | Yes |
Addresses
Primary practice location
100 Prison Rd
Represa, CA 95671-3000
Mailing address
1100 Roseville Pkwy
Apt. # 1028
Roseville, CA 95678-4100
Phone (916) 749-3511
Other providers in Represa, CA
- Joseph A Costa
- Rachel Ann Couzens
- Franklin Clarke Curren
- Lynne Demartini
- Harry Moran Singh Dhesi
- Jennifer Dominguez
- Grace Louise Downing
- John Phillip Dunlap Jr.
- Shannon Taylor Egan-Mooney
- Marsha Evans
All providers in Represa, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.