Provider Demographics
NPI:1528154291
Name:MATTHEW, DIANE H
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:H
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25050 PEACHLAND AVE
Mailing Address - Street 2:#203
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2523
Mailing Address - Country:US
Mailing Address - Phone:661-222-2800
Mailing Address - Fax:
Practice Address - Street 1:25050 PEACHLAND AVE
Practice Address - Street 2:#203
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2523
Practice Address - Country:US
Practice Address - Phone:661-222-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical