Provider Demographics
NPI:1023177839
Name:MATTHEWS, DIANE LUCILLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LUCILLE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15524 SHERMAN WAY
Mailing Address - Street 2:#109
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4104
Mailing Address - Country:US
Mailing Address - Phone:818-901-6155
Mailing Address - Fax:
Practice Address - Street 1:15524 SHERMAN WAY
Practice Address - Street 2:#109
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4104
Practice Address - Country:US
Practice Address - Phone:818-901-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS140311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical