Physician Compare National (NPI:1023130960)

HEALTHCARE PROVIDER: PATRICIO DHIMITRI PSYCHOLOGIST

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1023130960
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002075363
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120912000425
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DHIMITRI
	Individual professional last name
Provider First Name	PATRICIO
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	599 CANAL ST
	Group Practice or individual's line 1 address
City	LAWRENCE
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	018401244
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9786876488
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y