Provider Demographics
NPI:1366521437
Name:DIMEGLIO, CARLEEN ANNE (MSN,RN, PMHCNS/NP-BC)
Entity type:Individual
Prefix:MS
First Name:CARLEEN
Middle Name:ANNE
Last Name:DIMEGLIO
Suffix:
Gender:F
Credentials:MSN,RN, PMHCNS/NP-BC
Other - Prefix:
Other - First Name:CARLEEN
Other - Middle Name:ANNE
Other - Last Name:RISELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,RN, PMHCNS/NP-BC
Mailing Address - Street 1:201 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2333
Mailing Address - Country:US
Mailing Address - Phone:703-517-3182
Mailing Address - Fax:
Practice Address - Street 1:201 SENECA RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2333
Practice Address - Country:US
Practice Address - Phone:703-517-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA263554-PC364SP0809X
VA0024170236363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult