Provider Demographics
NPI:1134987381
Name:EISENMAN, DIANE LOUISE (CA LMFT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:EISENMAN
Suffix:
Gender:F
Credentials:CA LMFT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LOUISE
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1972 E ORANGE GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104
Mailing Address - Country:US
Mailing Address - Phone:818-618-1565
Mailing Address - Fax:626-578-9147
Practice Address - Street 1:1972 E ORANGE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104
Practice Address - Country:US
Practice Address - Phone:818-618-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT8792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist