Provider Demographics
NPI:1386757367
Name:SELOVER, DIANA ACEVEDO (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ACEVEDO
Last Name:SELOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 E BADILLO ST APT A
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3012
Mailing Address - Country:US
Mailing Address - Phone:626-332-4579
Mailing Address - Fax:818-895-5858
Practice Address - Street 1:16111 PLUMMER ST
Practice Address - Street 2:BUILDING 10
Practice Address - City:SEPULVEDA
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:818-895-5858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS95781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical