Provider Demographics
NPI:1184833683
Name:SAGEN, DIANE (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SAGEN
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 1:1000 QUAIL ST
Mailing Address - Street 2:SUITE 175
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2731
Mailing Address - Country:US
Mailing Address - Phone:714-269-4061
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST
Practice Address - Street 2:SUITE 175
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2731
Practice Address - Country:US
Practice Address - Phone:714-269-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist