Provider Demographics
NPI:1629108139
Name:CAMELLO, DIANA ELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ELENA
Last Name:CAMELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:ELENA
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23701 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5745
Mailing Address - Country:US
Mailing Address - Phone:310-816-5447
Mailing Address - Fax:
Practice Address - Street 1:23701 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5745
Practice Address - Country:US
Practice Address - Phone:310-816-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA702121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner