Provider Demographics
NPI:1265658157
Name:MEADOW, DIANE MARCY (MSW PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARCY
Last Name:MEADOW
Suffix:
Gender:F
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23891 BOTHNIA BAY
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4403
Mailing Address - Country:US
Mailing Address - Phone:949-707-5191
Mailing Address - Fax:949-496-6027
Practice Address - Street 1:15615 ALTON PKWY
Practice Address - Street 2:STE 220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-707-5191
Practice Address - Fax:949-496-6027
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS57021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical