Theresa Marie Dicamillo, MEDICAL ASSISTANT

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

2745171 Issued in CO

Practice address

4851 Independence St
Wheat Ridge, CO 80033-6715

Phone

(303) 432-5040

NPI assigned

Jul 25, 2015

Last updated

Jul 25, 2015By 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1437782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437782400000",
    "number": "1710362215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-432-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-432-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICAMILLO",
        "first_name": "THERESA",
        "middle_name": "MARIE",
        "credential": "MEDICAL ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-25",
        "last_updated": "2015-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "CO",
            "license": "2745171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BASIC LIFE SUPPORT",
            "identifier": "20308",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN MEDICAL TECHNOLOGISTS",
            "identifier": "2745171",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Glass, LCSW, LCC
• Dena Kayanne Diaz, RN
• Karla Marie Diaz, MA, LPCC
• Kevin Diaz
• Kylee Jo Dibona
• Alessia Dicicco
• Kendra Marie Dickson, LCSW
• Christa Dierking
• Diiorio Corporation (PrimeCare Colorado)
• Renee Dille, MD

• Prescribing (Medical) Psychologist in Wheat Ridge, CO
• Providers in Wheat Ridge, CO by specialty
• Prescribing (Medical) Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2015; 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.