Provider Demographics
NPI:1770121881
Name:KALJIAN, DIANE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:KALJIAN
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 1:57 VIVIAN CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2875
Mailing Address - Country:US
Mailing Address - Phone:415-717-6361
Mailing Address - Fax:
Practice Address - Street 1:57 VIVIAN CT
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-2875
Practice Address - Country:US
Practice Address - Phone:415-717-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS107831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical