Basic Information
| Provider Information | |||||||||
| NPI: | 1215480603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | CAROLINA | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13650 RAYEN ST | ||||||||
| Address2: | |||||||||
| City: | ARLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913315627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187442545 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6400 LAUREL CANYON BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916061562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189016376 | ||||||||
| FaxNumber: | 8189049273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2016 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 72713 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 104869 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.