Healthcare Provider Details

I. General information

NPI: 1477612836
Provider Name (Legal Business Name): STEPHEN PAUL DALCERRO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CTY RD R
BLACK RIVER FALLS WI
54615
US

IV. Provider business mailing address

1707 MAIN ST
LA CROSSE WI
54601-4200
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-9477
  • Fax: 715-284-5547
Mailing address:
  • Phone: 608-785-0001
  • Fax: 608-785-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1949-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: