Provider Demographics
NPI:1780820563
Name:GOLDMAN DE ZOCCHI, DIANA (MA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GOLDMAN DE ZOCCHI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 PALMER CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5672
Mailing Address - Country:US
Mailing Address - Phone:630-689-1511
Mailing Address - Fax:
Practice Address - Street 1:2215 PALMER CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5672
Practice Address - Country:US
Practice Address - Phone:630-689-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-27
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health