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NPI Code Detail

MEDICARE: DIANE DENISE FJELSTAD LCSW

MEDICARE: DIANE DENISE FJELSTAD 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 WorkerLCS 9742CA

General Provider Information

NPI Number : 1811036866
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE DENISE FJELSTAD LCSW
Provider Business Mailing Address
First Line : 650 S BASCOM AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95128-2601
Country : US
Telephone Number : 408-793-5873
Fax Number :
Provider Business Practice Location Address
First Line : 650 S BASCOM AVE
Second Line :
City : SAN JOSE
State : CA
Zip : 95128-2601
Country : US
Telephone Number : 408-793-5870
Fax Number : 408-275-6716
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2007

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Directions to “ DIANE DENISE FJELSTAD LCSW” Practice Location

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