Provider Demographics
NPI:1588185284
Name:OFFNER, DIANE SNELL (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:SNELL
Last Name:OFFNER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1533
Mailing Address - Country:US
Mailing Address - Phone:909-624-0995
Mailing Address - Fax:
Practice Address - Street 1:250 W 1ST ST STE 242
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4742
Practice Address - Country:US
Practice Address - Phone:909-624-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS120911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS12091OtherCALIFORNIA STATE LICENSE SOCIAL WORK
CA881822817OtherNATIONAL ASSOCIATION OF SOCIAL WORKERS