Provider Demographics
NPI:1962049973
Name:CARAWAY, DIANTE MIGUEL
Entity type:Individual
Prefix:
First Name:DIANTE
Middle Name:MIGUEL
Last Name:CARAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 CROW CANYON PL STE 170
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1728
Mailing Address - Country:US
Mailing Address - Phone:925-659-8851
Mailing Address - Fax:
Practice Address - Street 1:3150 CROW CANYON PL STE 170
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1728
Practice Address - Country:US
Practice Address - Phone:925-659-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3237117103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst