Provider Demographics
NPI:1518177468
Name:KAY, DIANE D (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:D
Last Name:KAY
Suffix:
Gender:F
Credentials:MSW, PHD
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 2744
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-8744
Mailing Address - Country:US
Mailing Address - Phone:310-528-4050
Mailing Address - Fax:
Practice Address - Street 1:205 AVENUE I
Practice Address - Street 2:SUITE 28
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5619
Practice Address - Country:US
Practice Address - Phone:310-528-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS206121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical