Healthcare Provider Details

I. General information

NPI: 1447498753
Provider Name (Legal Business Name): DIANN WARSAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE BLDG 18
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

3850 CRENSHAW BLVD
LOS ANGELES CA
90008-1821
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-6015
  • Fax:
Mailing address:
  • Phone: 323-751-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW99542
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99452
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberASW99542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: