Healthcare Provider Details

I. General information

NPI: 1760447155
Provider Name (Legal Business Name): LUKE RICHARD DALFIUME PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 W BRIGHTON AVE
PEORIA IL
61615
US

IV. Provider business mailing address

3716 W BRIGHTON AVENUE JOHN R DAY AND ASSOCIATES
PEORIA IL
61615
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-7755
  • Fax: 309-692-2262
Mailing address:
  • Phone: 309-692-7755
  • Fax: 309-692-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: