Provider Demographics
NPI:1336657196
Name:DIEBEL, RITA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:A
Last Name:DIEBEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RITA
Other - Middle Name:A
Other - Last Name:DIEBEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2464
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-2464
Mailing Address - Country:US
Mailing Address - Phone:415-816-1232
Mailing Address - Fax:
Practice Address - Street 1:1730 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3012
Practice Address - Country:US
Practice Address - Phone:415-753-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS139061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical