Provider Demographics
NPI:1740312883
Name:KRISHUN, DIANA RUTH (LCSW CBD)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:RUTH
Last Name:KRISHUN
Suffix:
Gender:
Credentials:LCSW CBD
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:RUTH
Other - Last Name:KRISHUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW 523
Mailing Address - Street 1:26015 NARBONNE AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3026
Mailing Address - Country:US
Mailing Address - Phone:323-345-4969
Mailing Address - Fax:310-530-9475
Practice Address - Street 1:2230 CRENSHAW BLVD
Practice Address - Street 2:SUITE A-2
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:323-345-4969
Practice Address - Fax:310-530-9475
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 5231041C0700X
CALCS 523 CBD95111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11401259OtherCAQH