MEDICARE: BRONWEN CAMERON DIANTONIO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2002021874	MO

General Provider Information

NPI Number	:	1558422709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRONWEN CAMERON DIANTONIO PH.D.

Provider Business Mailing Address
First Line	:	9440 BONHOMME WOODS DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3405
Country	:	US
Telephone Number	:	314-989-9761
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:	SUITE 1601
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-862-2305
Fax Number	:	314-862-3425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/09/2007

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Directions to “ BRONWEN CAMERON DIANTONIO PH.D.” Practice Location

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