Provider Demographics
NPI:1821605791
Name:GASTON, DIANE F (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:GASTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:F
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 261598
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-1598
Mailing Address - Country:US
Mailing Address - Phone:858-610-1871
Mailing Address - Fax:
Practice Address - Street 1:9815 CARROLL CANYON RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1123
Practice Address - Country:US
Practice Address - Phone:858-201-8496
Practice Address - Fax:855-821-0667
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW190641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical