Provider Demographics
NPI:1720109531
Name:LEROI, DIANE CHRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:CHRISTINE
Last Name:LEROI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:CHRISTINE
Other - Last Name:LIGHTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 N SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2608
Mailing Address - Country:US
Mailing Address - Phone:650-340-1651
Mailing Address - Fax:650-348-7888
Practice Address - Street 1:221 N SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2608
Practice Address - Country:US
Practice Address - Phone:650-340-1651
Practice Address - Fax:650-348-7888
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical