Provider Demographics
NPI:1639831134
Name:ESPARZA, DIANA CAREN (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CAREN
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GENERAL HODGES ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1019
Mailing Address - Country:US
Mailing Address - Phone:505-910-7303
Mailing Address - Fax:
Practice Address - Street 1:2612 TEXAS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4684
Practice Address - Country:US
Practice Address - Phone:505-830-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-12112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker