Provider Demographics
NPI:1801988431
Name:DINER, RALPH G (PHD, MSCP)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:G
Last Name:DINER
Suffix:
Gender:M
Credentials:PHD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20541 HIAWATHA ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2413
Mailing Address - Country:US
Mailing Address - Phone:818-231-2164
Mailing Address - Fax:
Practice Address - Street 1:16944 VENTURA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4161
Practice Address - Country:US
Practice Address - Phone:818-231-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPC7457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical