Provider Demographics
NPI:1891073250
Name:DIANGSON, KATHRYN J
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:DIANGSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:DIANGSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:6572 CAMDEN AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-1807
Mailing Address - Country:US
Mailing Address - Phone:408-656-5003
Mailing Address - Fax:408-323-2222
Practice Address - Street 1:6572 CAMDEN AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-1807
Practice Address - Country:US
Practice Address - Phone:408-656-5003
Practice Address - Fax:408-323-2222
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist