Healthcare Provider Details

I. General information

NPI: 1225643786
Provider Name (Legal Business Name): DIANE GARCIA MSW, PH.D., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N. ROXBURY DRIVE SUITE 218
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

436 N. ROXBURY DRIVE SUITE 218
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-552-1369
  • Fax: 310-552-2645
Mailing address:
  • Phone: 310-552-1369
  • Fax: 310-552-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW6049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: