Provider Demographics
NPI:1629103965
Name:CASE-GURTIN, DIANA SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:SUE
Last Name:CASE-GURTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:SUE
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:933 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4425
Mailing Address - Country:US
Mailing Address - Phone:831-236-6060
Mailing Address - Fax:831-747-2586
Practice Address - Street 1:933 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4425
Practice Address - Country:US
Practice Address - Phone:831-236-6060
Practice Address - Fax:831-747-2586
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11998103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY11998OtherPSYCHOLOGY LICENSE
CA0PL119980Medicare UPIN