Provider Demographics
NPI:1235396813
Name:DESPOSITO, DIANA MICHELE (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MICHELE
Last Name:DESPOSITO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MICHELE
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1333 IRIS
Mailing Address - Street 2:BOULDER COUNTY MENTAL HEALTH CENTER
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:303-443-8500
Mailing Address - Fax:720-406-3603
Practice Address - Street 1:1333 IRIS
Practice Address - Street 2:BOULDER COUNTY MENTAL HEALTH CENTER
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304
Practice Address - Country:US
Practice Address - Phone:303-443-8500
Practice Address - Fax:720-406-3603
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9898091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical