| Doctor Name: | DR. MELINDA SUSAN DICIRO |
| NPI Number: | 1043489800 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | CA18482 |
| Business Practice Address: | 100 Prison Rd Represa, CA - 956713000 |
| Business Phone Number: | 9169858610 |
| Business Fax Number: | |
| Mailing Address: | 1100 Roseville Pkwy, Apt. # 1028 ROSEVILLE |
| State: | CA |
| Postal Code: | 956784100 |
| Phone Number: | 9167493511 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2008 |
| NPI Last Update Date: | 02/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | CA18482 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |