Justin Dallacqua, J.D., PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

4681 Issued in AZ

Practice address

408 N Kendrick St
Suite 3
Flagstaff, AZ 86001-1582

Phone

(602) 456-2148

NPI assigned

Dec 4, 2015

Sex

Male

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

Credentials

Juris Doctor

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dallacqua Psychology, LLC

  • Community/Behavioral Health Agency
  • Flagstaff, AZ
  • NPI 1720707391
  NPD Authorized official
• Public Safety Psychology Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Littleton, CO
  • NPI 1588402945
  NPD Authorized official

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

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449187200000",
    "number": "1780059584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 E UNIVERSITY DR",
            "address_2": "SUITE G",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852037961",
            "telephone_number": "602-456-2148",
            "fax_number": "480-718-8619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 N KENDRICK ST",
            "address_2": "SUITE 3",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011582",
            "telephone_number": "602-456-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLACQUA",
        "first_name": "JUSTIN",
        "credential": "J.D., PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-04",
        "last_updated": "2015-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "4681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Dahm, DDS
• Suzanne R. Daiss, PH.D.
• Emily Dale, CPM, LM
• Scott Morrison Dale, MD
• Dallacqua Psychology, LLC
• Daniel Wayne Dalton, R.PH.
• Joshua Ruben Damian, M.D.
• Aleksandra Daniel
• Jeffrey Todd Daniel, M.D
• Brian J Daniels, LAC

• Psychologist in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.