Provider Demographics
NPI:1215353792
Name:DIEFENBACHER, NADINE (MFT)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:
Last Name:DIEFENBACHER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SUNRISE BLVD STE C5
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4942
Mailing Address - Country:US
Mailing Address - Phone:916-384-6548
Mailing Address - Fax:916-928-3116
Practice Address - Street 1:5050 SUNRISE BLVD STE C5
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-384-6548
Practice Address - Fax:916-928-3116
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT40381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist