Provider Demographics
NPI:1922869791
Name:GRIMAUD, DIANA CAROLINA (ACSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROLINA
Last Name:GRIMAUD
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CAROLINA
Other - Last Name:VERDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1763 ARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3625
Mailing Address - Country:US
Mailing Address - Phone:156-241-3152
Mailing Address - Fax:
Practice Address - Street 1:1763 ARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-3625
Practice Address - Country:US
Practice Address - Phone:626-996-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA947881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty