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General NPI Number Information
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NPI Number | 1922303999
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Entity Type | Individual
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Provider Name | DIANNA STARK LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 32242 PASEO ADELANTO SUITE D5
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3610
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Country | US
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Telephone | 917-637-0912
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6384
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-6384
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Country | US
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Telephone | 917-637-0912
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R055741-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS65442
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License Number State | CA
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