=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477612836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN PAUL DALCERRO PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 CTY RD R
-----------------------------------------------------
City | BLACK RIVER FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-284-9477
-----------------------------------------------------
Fax | 715-284-5547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1707 MAIN ST
-----------------------------------------------------
City | LA CROSSE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54601-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-785-0001
-----------------------------------------------------
Fax | 608-785-0002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number | 1949-057
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------