Provider Demographics
NPI:1063727949
Name:DICARLO, DIANE ALANA (LAC, LMT)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ALANA
Last Name:DICARLO
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ALANA
Other - Last Name:SCHIMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:638 OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716
Mailing Address - Country:US
Mailing Address - Phone:516-640-6930
Mailing Address - Fax:631-265-0552
Practice Address - Street 1:638 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716
Practice Address - Country:US
Practice Address - Phone:516-640-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27-023821225700000X
NY005974-1171100000X
NY023821-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty