MEDICARE: DIANNA KALPAKIAN, PHD LLC

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1619660420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANNA KALPAKIAN, PHD LLC

Provider Business Mailing Address
First Line	:	15362 SWEET SPRINGS BND
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2943
Country	:	US
Telephone Number	:	727-773-5669
Fax Number	:

Provider Business Practice Location Address
First Line	:	15362 SWEET SPRINGS BND
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2943
Country	:	US
Telephone Number	:	727-773-5669
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. DIANNA MARY KALPAKIAN
Credential	:	PHD
Telephone Number	:	727-773-5669

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	05/29/2023

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