Provider Demographics
NPI:1457667685
Name:THORP, DIANE MARIE (MSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:THORP
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:233 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3522
Mailing Address - Country:US
Mailing Address - Phone:818-395-9853
Mailing Address - Fax:
Practice Address - Street 1:55 9TH ST
Practice Address - Street 2:
Practice Address - City:CAYUCOS
Practice Address - State:CA
Practice Address - Zip Code:93430-1301
Practice Address - Country:US
Practice Address - Phone:818-395-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA655671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical