Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 16784 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 16784 | CA |
N | 102L00000X | Psychologist | PSY 16784 | CA |
N | 103T00000X | Psychologist | PSY 16784 | CA |
NPI | 1003149279 |
---|---|
Provider Name | Dr. Diana Louise Trichilo |
First Address | Sebastopol, CA 95473-2795 |
Second Address | Sebastopol, CA 95472-3747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2009 |
Last Update Date | 06/03/2017 |