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1558464958 NPI number — DIANE ARLENE STARKENBURG PSYD, MSCP

NPI Number: 1558464958
Health Care Provider/Practitioner: DIANE ARLENE STARKENBURG PSYD, MSCP

Information about “1558464958” NPI (DIANE ARLENE STARKENBURG PSYD, MSCP) exists in 1558464958 in HTML format HTML  |  1558464958 in plain Text format TXT  |  1558464958 in PDF (Portable Document Format) PDF  |  1558464958 in an XML format XML  formats.

NPI Number : 1558464958 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558464958",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STARKENBURG",
    "FirstName": "DIANE",
    "MiddleName": "ARLENE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PSYD, MSCP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BOYSEN",
    "OtherFirstName": "DIANE",
    "OtherMiddleName": "ARLENE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1505 15TH ST STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ALAMOS",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87544-3000",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-500-5894",
    "MailingAddressFaxNumber": "505-557-1140",
    "FirstLinePracticeLocationAddress": "1505 15TH ST STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ALAMOS",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87544-3000",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-500-5894",
    "PracticeLocationAddressFaxNumber": "505-557-1140",
    "EnumerationDate": "09/07/2006",
    "LastUpdateDate": "03/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "1134",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TP0016X",
          "TaxonomyName": "Prescribing (Medical) Psychologist",
          "LicenseNumber": "PSY-2024-0068",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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