Provider Demographics
NPI:1164511630
Name:AVELAR, DIANNE MARIA (MFT)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:MARIA
Last Name:AVELAR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2071
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-2071
Mailing Address - Country:US
Mailing Address - Phone:831-673-1220
Mailing Address - Fax:
Practice Address - Street 1:10096 SOQUEL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4938
Practice Address - Country:US
Practice Address - Phone:831-662-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36967106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist