Provider Demographics
NPI:1285823195
Name:ELLER-BOYKO, DIANE M (RN,MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ELLER-BOYKO
Suffix:
Gender:F
Credentials:RN,MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0121
Mailing Address - Country:US
Mailing Address - Phone:909-798-1925
Mailing Address - Fax:951-351-2013
Practice Address - Street 1:11530 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4853
Practice Address - Country:US
Practice Address - Phone:909-798-1925
Practice Address - Fax:951-351-2013
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS147641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical