Provider Demographics
NPI:1841746898
Name:AZEVEDO, DIANE NORMANDIN (M,A,, LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:NORMANDIN
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:M,A,, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 LOS GATOS BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2017
Mailing Address - Country:US
Mailing Address - Phone:408-358-2876
Mailing Address - Fax:
Practice Address - Street 1:15000 LOS GATOS BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2017
Practice Address - Country:US
Practice Address - Phone:408-358-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist