Provider Demographics
NPI:1235335951
Name:PETRONI, DIANE CAROLE (PHD MFT)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:CAROLE
Last Name:PETRONI
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:PETRONI NEWHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4990 SPEAK LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2776
Mailing Address - Country:US
Mailing Address - Phone:408-266-7826
Mailing Address - Fax:408-267-9649
Practice Address - Street 1:4990 SPEAK LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2776
Practice Address - Country:US
Practice Address - Phone:408-266-7826
Practice Address - Fax:408-267-9649
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17004103TP0814X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist