Provider Demographics
NPI:1043384860
Name:DILISCIA, ANTHONY CARMEN (PHD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CARMEN
Last Name:DILISCIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PENN CENTER BLVD
Mailing Address - Street 2:SUITE 612
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5507
Mailing Address - Country:US
Mailing Address - Phone:412-829-2001
Mailing Address - Fax:412-829-2016
Practice Address - Street 1:300 PENN CENTER BLVD
Practice Address - Street 2:SUITE 612
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5507
Practice Address - Country:US
Practice Address - Phone:412-829-2001
Practice Address - Fax:412-829-2016
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005488L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R91214Medicare UPIN
616717Medicare ID - Type Unspecified