MEDICARE: DR. CHRISTINA JACQUELINE DICHIARA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS017615	PA

General Provider Information

NPI Number	:	1013317288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA JACQUELINE DICHIARA PSY.D.

Provider Business Mailing Address
First Line	:	2531 TRENTON AVE APT 405
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1715
Country	:	US
Telephone Number	:	215-512-6162
Fax Number	:

Provider Business Practice Location Address
First Line	:	2531 TRENTON AVE APT 405
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1715
Country	:	US
Telephone Number	:	215-512-6162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	08/25/2014

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