Provider Demographics
NPI:1396480463
Name:SEMANCIK, DIANE KIMBERLY (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:KIMBERLY
Last Name:SEMANCIK
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:PSC 819 BOX 3278
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE JOSE ESTEVEZ DE LOS REYES, 7
Practice Address - Street 2:
Practice Address - City:ROTA
Practice Address - State:ANDALUSIA
Practice Address - Zip Code:11520
Practice Address - Country:ES
Practice Address - Phone:541-306-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00011611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical