Provider Demographics
NPI:1225643786
Name:GARCIA, DIANE (MSW, PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MSW, PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N. ROXBURY DRIVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-552-1369
Mailing Address - Fax:310-552-2645
Practice Address - Street 1:436 N. ROXBURY DRIVE
Practice Address - Street 2:SUITE 218
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-552-1369
Practice Address - Fax:310-552-2645
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW60491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty