Diane Mitzenmacher, LCSW
Social Worker, Clinical in Rancho Cucuamonga, CA. Individual provider (NPI-1).
NPI number1649366394
StatusActive
Last updated in NPPESJun 8, 2023
Details
- NPI
- 1649366394
- Entity type
- Individual (NPI-1)
- Name
- Diane Mitzenmacher
- Credential
- LCSW
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 4, 2006
- Certification date
- Jun 8, 2023
- Last updated
- Jun 8, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | LCSW19655 | CA | Yes |
| 1041C0700X | Social Worker, Clinical | lcs19655 | CA | |
| 1041C0700X | Social Worker, Clinical | BCD#29518 | CA |
Practice location
8300 Utica Ave #155Rancho Cucuamonga, CA 91730-7605
Phone 909-285-5205 · Fax 909-285-2103
Mailing address
Po Box 938Rancho Cucamonga, CA 91729-0938
Phone 909-285-5205 · Fax 909-285-2103
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