Provider Demographics
NPI:1710572557
Name:EATON, DIANA KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:KAY
Last Name:EATON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:KAY
Other - Last Name:ANNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:483 FOREST AVE APT F
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2632
Mailing Address - Country:US
Mailing Address - Phone:530-200-1440
Mailing Address - Fax:
Practice Address - Street 1:483 FOREST AVE APT F
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2632
Practice Address - Country:US
Practice Address - Phone:530-200-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical