=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932193257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER A. DIANI LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 03/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 GOUGH ST STE 403
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-5971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-585-4250
-----------------------------------------------------
Fax | 415-585-4250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 GOUGH ST STE 403
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-5971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-585-4250
-----------------------------------------------------
Fax | 415-585-4250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS20024
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------