Provider Demographics
NPI:1790445567
Name:RESTREPO, DIANE KATHLEEN (MSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KATHLEEN
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33422 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1514
Mailing Address - Country:US
Mailing Address - Phone:612-296-1686
Mailing Address - Fax:
Practice Address - Street 1:33422 VALLEY VIEW CT
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1514
Practice Address - Country:US
Practice Address - Phone:612-296-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty