Provider Demographics
NPI:1790559490
Name:ZENDEJAS MAGALLON, DIANE HELEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:HELEN
Last Name:ZENDEJAS MAGALLON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 JUBILEE WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-8210
Mailing Address - Country:US
Mailing Address - Phone:209-898-9677
Mailing Address - Fax:
Practice Address - Street 1:582 E HARDING WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6110
Practice Address - Country:US
Practice Address - Phone:209-645-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW997151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical