MEDICARE: DIANE C SIMONI LICSW

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	113324	MA

General Provider Information

NPI Number	:	1871681643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE C SIMONI LICSW

Provider Business Mailing Address
First Line	:	317 CAROB LN
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-6623
Country	:	US
Telephone Number	:	508-243-7481
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 CAROB LN
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-6623
Country	:	US
Telephone Number	:	508-243-7481
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	12/14/2020

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