Provider Demographics
NPI:1093217481
Name:HALPERIN, DIANE SUE (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:SUE
Last Name:HALPERIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 LOS VERDES DR APT 1
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5679
Mailing Address - Country:US
Mailing Address - Phone:310-508-6755
Mailing Address - Fax:
Practice Address - Street 1:6800 LOS VERDES DR APT 1
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5679
Practice Address - Country:US
Practice Address - Phone:310-508-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT24732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist