Provider Demographics
NPI:1255431821
Name:DEFREECE, DIANNE LORRAINE (PSYD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:LORRAINE
Last Name:DEFREECE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W LANCASTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2253
Mailing Address - Country:US
Mailing Address - Phone:661-948-7990
Mailing Address - Fax:
Practice Address - Street 1:1345 W LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2253
Practice Address - Country:US
Practice Address - Phone:661-948-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7849533Medicare UPIN
CA7849533Medicare UPIN