MEDICARE: DR. KRISTA J DIVITTORE PSYD

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	103T00000X	Psychologist	10612	MA
2	103TC0700X	Clinical Psychologist	PY60980309	WA
3	103TC0700X	Clinical Psychologist	MSPSY.0000004	CO
4	103TC0700X	Clinical Psychologist	1742	HI
5	103TC0700X	Clinical Psychologist	PSY.0006288	CO

General Provider Information

NPI Number	:	1760905764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTA J DIVITTORE PSYD

Provider Business Mailing Address
First Line	:	20971 E SMOKY HILL RD STE 204
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-5187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20971 E SMOKY HILL RD STE 204
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-5187
Country	:	US
Telephone Number	:	720-347-8559
Fax Number	:

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

Provider Enumeration Date	:	07/21/2017
Last Update Date	:	11/30/2023

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