Provider Demographics
NPI:1538353503
Name:DIANE H. ANDERSON, LCSW
Entity type:Organization
Organization Name:DIANE H. ANDERSON, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:HUTT
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-332-0556
Mailing Address - Street 1:750 TERRADO PLZ
Mailing Address - Street 2:SUITE 40
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3419
Mailing Address - Country:US
Mailing Address - Phone:626-332-0556
Mailing Address - Fax:626-332-6587
Practice Address - Street 1:750 TERRADO PLZ
Practice Address - Street 2:SUITE 40
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3419
Practice Address - Country:US
Practice Address - Phone:626-332-0556
Practice Address - Fax:626-332-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS229961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty