Healthcare Provider Details

I. General information

NPI: 1982730479
Provider Name (Legal Business Name): DIANA CARADONNA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE # C-2
CERES CA
95307-4562
US

IV. Provider business mailing address

3425 JOHN LEE LN
MODESTO CA
95350-0945
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4600
  • Fax:
Mailing address:
  • Phone: 209-818-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number93347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: