MEDICARE: DIANE ARLENE STARKENBURG PSYD, MSCP

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	103TC0700X	Clinical Psychologist	1134	NM
2	103TP0016X	Prescribing (Medical) Psychologist	PSY-2024-0068	NM

General Provider Information

NPI Number	:	1558464958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ARLENE STARKENBURG PSYD, MSCP

Provider Business Mailing Address
First Line	:	1505 15TH ST STE A
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3000
Country	:	US
Telephone Number	:	505-500-5894
Fax Number	:	505-557-1140

Provider Business Practice Location Address
First Line	:	1505 15TH ST STE A
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3000
Country	:	US
Telephone Number	:	505-500-5894
Fax Number	:	505-557-1140

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	03/23/2025

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