Provider Demographics
NPI:1669538831
Name:VANARSDALE, DIANE BARBARA (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:BARBARA
Last Name:VANARSDALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:BARBARA
Other - Last Name:VAN ARSDALE-HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:801 E 2ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3347
Mailing Address - Country:US
Mailing Address - Phone:707-416-6525
Mailing Address - Fax:
Practice Address - Street 1:801 E 2ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3347
Practice Address - Country:US
Practice Address - Phone:707-416-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS874ZMedicare PIN