Healthcare Provider Details

I. General information

NPI: 1427113596
Provider Name (Legal Business Name): ELIZABETH SARAH DINERMAN MA, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 E BROADWAY RD SUITE 120
TEMPE AZ
85282-1511
US

IV. Provider business mailing address

1001 W PENINSULA DR
GILBERT AZ
85233-6746
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax:
Mailing address:
  • Phone: 480-784-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-12249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: