Healthcare Provider Details

I. General information

NPI: 1851887251
Provider Name (Legal Business Name): ROBERT DICARLO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 E RAINTREE DR STE 120
SCOTTSDALE AZ
85260-2691
US

IV. Provider business mailing address

8350 E RAINTREE DR STE 120
SCOTTSDALE AZ
85260-2691
US

V. Phone/Fax

Practice location:
  • Phone: 480-840-0400
  • Fax: 480-840-0499
Mailing address:
  • Phone: 480-840-0400
  • Fax: 480-840-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY-004980
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY-004980
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY-004980
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY-004980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: