Active NPI
John Philip Dibacco, PHD
- Forensic Psychologist
- Phoenix, AZ
National Provider Identifier
1447480538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- 524
- Practice address
- 11811 N Tatum Blvd
P115
Phoenix, AZ 85028-1614 - Phone
- (602) 953-6165
- NPI assigned
- Jul 23, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Forensic Psychologist | 103TF0200X | 524 | AZ | Primary |
| Forensic Psychologist | 103TF0200X | 131 | NV |
Addresses
Primary practice location
11811 N Tatum Blvd
P115
Phoenix, AZ 85028-1614
Mailing address
11811 N Tatum Blvd
P115
Phoenix, AZ 85028-1614
Phone (602) 953-6165
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 524 | AZ | MD | Forensic Psychologist |
| 131 | NV | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248307200000",
"number": "1447480538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11811 N TATUM BLVD",
"address_2": "P115",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850281614",
"telephone_number": "602-953-6165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11811 N TATUM BLVD",
"address_2": "P115",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850281614",
"telephone_number": "602-953-6165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIBACCO",
"first_name": "JOHN",
"middle_name": "PHILIP",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-23",
"last_updated": "2009-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "AZ",
"license": "524",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "NV",
"license": "131",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.