Tara Dibattisto, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9151 Issued in FL

Practice address

4310 Metro Pkwy Ste 205
Fort Myers, FL 33916-9416

Phone

(239) 223-2751

Fax

(239) 561-2933

NPI assigned

Dec 15, 2020

Last updated

Dec 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1619563533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 METRO PKWY STE 205",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339169416",
            "telephone_number": "239-236-8784",
            "fax_number": "239-790-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 METRO PKWY STE 205",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339169416",
            "telephone_number": "239-223-2751",
            "fax_number": "239-561-2933"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2625 Executive Park Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Weston",
            "state": "FL",
            "postal_code": "333313634",
            "country_code": "US",
            "telephone_number": "239-223-2751",
            "fax_number": "239-561-2933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIBATTISTO",
        "first_name": "TARA",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-15",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liosdan Diaz
• Mariah Isha Diaz
• Natalie Diaz, BCBA
• Raul Diaz, M.D.
• Veronica Diaz, APRN
• Monique P Dibbs Vallee, MD
• Christine Marie Dibenedetto, PSY D
• Frank Peter Diblase, D.C
• Dicenzo Enterprises Incorporated (Assisting Hands Home Care - Lee & Charlotte County)
• Maurice H Dick, MD

• Clinical Psychologist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.