Provider Demographics
NPI:1982983516
Name:PICKETT, DIANA LYNN (MA, MD, PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MA, MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 JEWELL ST
Mailing Address - Street 2:N202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6013
Mailing Address - Country:US
Mailing Address - Phone:858-333-1086
Mailing Address - Fax:
Practice Address - Street 1:3940 HANCOCK ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5157
Practice Address - Country:US
Practice Address - Phone:858-246-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24337103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical