Provider Demographics
NPI:1336201441
Name:SHIMKUS, DIANA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARIE
Last Name:SHIMKUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:KOVALCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW
Mailing Address - Street 1:826 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4408
Mailing Address - Country:US
Mailing Address - Phone:760-310-2920
Mailing Address - Fax:760-436-9862
Practice Address - Street 1:826 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4408
Practice Address - Country:US
Practice Address - Phone:760-310-2920
Practice Address - Fax:760-436-9862
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS114401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA11440Medicare ID - Type UnspecifiedMEDICARE SOCIAL WORKER