Provider Demographics
NPI:1487146023
Name:NGUYEN, MY DIEM (LMSW)
Entity type:Individual
Prefix:
First Name:MY DIEM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13385 LOS ALAMITOS CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-8406
Mailing Address - Country:US
Mailing Address - Phone:714-261-7674
Mailing Address - Fax:
Practice Address - Street 1:1695 S SAN JACINTO AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:951-330-3100
Practice Address - Fax:951-380-8596
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA1268031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner