Provider Demographics
NPI:1457459794
Name:SHENKIN, DIANA (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SHENKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BURBANK ST STE F
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1658
Mailing Address - Country:US
Mailing Address - Phone:970-250-3149
Mailing Address - Fax:
Practice Address - Street 1:710 BURBANK ST STE F
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1658
Practice Address - Country:US
Practice Address - Phone:970-250-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9895151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1457459794OtherVALLEY OPTIONS
CO1457459794OtherRMHMO
CO1457459794OtherANTHEM
CO1457459794OtherCNIC
CO1457459794OtherUNITED HEALTH CARE
CO1457459794OtherAETNA
CO1457459794OtherMHN MANAGED HEALTH NETWORK