Provider Demographics
NPI:1821481847
Name:ROSENBERG, DIANE (CADCII-AII28780618)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:CADCII-AII28780618
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11837 KEMPER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9067
Mailing Address - Country:US
Mailing Address - Phone:530-888-1010
Mailing Address - Fax:530-888-9065
Practice Address - Street 1:11837 KEMPER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9067
Practice Address - Country:US
Practice Address - Phone:530-888-1010
Practice Address - Fax:530-888-9065
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII2870618101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)