Provider Demographics
NPI:1427178177
Name:DICARIO, MARY JO (LMFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:DICARIO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-0267
Mailing Address - Country:US
Mailing Address - Phone:760-643-7479
Mailing Address - Fax:
Practice Address - Street 1:800 GRAND AVE
Practice Address - Street 2:SUITE B-15
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1808
Practice Address - Country:US
Practice Address - Phone:760-429-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT47843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist