Provider Demographics
NPI:1851636302
Name:DISKIN, RACHEL LAUREN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LAUREN
Last Name:DISKIN
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 1:917 THOMAS AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4025
Mailing Address - Country:US
Mailing Address - Phone:248-910-1961
Mailing Address - Fax:
Practice Address - Street 1:917 THOMAS AVE APT 13
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4025
Practice Address - Country:US
Practice Address - Phone:248-910-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010949241041C0700X
CA743581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical