Provider Demographics
NPI:1972882165
Name:APOLINAR, DIANA P (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:P
Last Name:APOLINAR
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 1:7725 S 69TH DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3434
Mailing Address - Country:US
Mailing Address - Phone:602-682-5315
Mailing Address - Fax:
Practice Address - Street 1:12725 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE E-101
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9520
Practice Address - Country:US
Practice Address - Phone:623-974-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ119341041C0700X
NY0712041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical