Provider Demographics
NPI:1558464958
Name:STARKENBURG, DIANE ARLENE (PSYD, MSCP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ARLENE
Last Name:STARKENBURG
Suffix:
Gender:
Credentials:PSYD, MSCP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ARLENE
Other - Last Name:BOYSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 15TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3000
Mailing Address - Country:US
Mailing Address - Phone:505-500-5894
Mailing Address - Fax:505-557-1140
Practice Address - Street 1:1505 15TH ST STE A
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3000
Practice Address - Country:US
Practice Address - Phone:505-500-5894
Practice Address - Fax:505-557-1140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1134103TC0700X
NMPSY-2024-0068103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical