MEDICARE: DIANN LYNN RICOKAAINOA 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
1	1041C0700X	Clinical Social Worker	23824	CA

General Provider Information

NPI Number	:	1457521049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANN LYNN RICOKAAINOA LCSW

Provider Business Mailing Address
First Line	:	1118 E GREEN ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2500
Country	:	US
Telephone Number	:	626-665-6274
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 E GREEN ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2500
Country	:	US
Telephone Number	:	213-471-0406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/14/2023

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