Provider Demographics
NPI:1437440476
Name:ENGELMAN, DIANE HOLLAND (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:HOLLAND
Last Name:ENGELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SIR FRANCIS DRAKE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1454
Mailing Address - Country:US
Mailing Address - Phone:415-721-7382
Mailing Address - Fax:415-721-7448
Practice Address - Street 1:1044 SIR FRANCIS DRAKE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1454
Practice Address - Country:US
Practice Address - Phone:415-721-7382
Practice Address - Fax:415-721-7448
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSY11457103G00000X
CAPSY11457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical