Provider Demographics
NPI:1861430803
Name:DIGIULIO, DIANE V (PH D)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:V
Last Name:DIGIULIO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33505
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-3505
Mailing Address - Country:US
Mailing Address - Phone:907-523-1973
Mailing Address - Fax:907-523-1974
Practice Address - Street 1:2770 SHERWOOD LN # D
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8568
Practice Address - Country:US
Practice Address - Phone:907-523-1973
Practice Address - Fax:907-523-1974
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK606103G00000X, 103TC0700X
WI1484-57103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS0018Medicaid
AKK163512Medicare PIN