Healthcare Provider Details

I. General information

NPI: 1407874878
Provider Name (Legal Business Name): MARGARET ANN DICARLO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY STE 8B
EAST PROVIDENCE RI
02914-5315
US

IV. Provider business mailing address

50 MAUDE ST ELMHURST 5TH FLOOR
PROVIDENCE RI
02908-4325
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2479
  • Fax: 401-456-2399
Mailing address:
  • Phone: 401-456-2479
  • Fax: 401-456-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS00679
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: