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NPI Code Detail

MEDICARE: DIANA NICOLE BLANK LCSW

MEDICARE: DIANA NICOLE BLANK LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker18202CA

General Provider Information

NPI Number : 1255749479
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA NICOLE BLANK LCSW
Provider Business Mailing Address
First Line : 1720 EL CAMINO REAL STE 140
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-3231
Country : US
Telephone Number : 925-282-1778
Fax Number :
Provider Business Practice Location Address
First Line : 1720 EL CAMINO REAL STE 140
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-3231
Country : US
Telephone Number : 925-282-1778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2014
Last Update Date : 05/28/2026

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Directions to “ DIANA NICOLE BLANK LCSW” Practice Location

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