Provider Demographics
NPI:1174321087
Name:DILLER, MARTIN (LMFT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DILLER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4245
Mailing Address - Country:US
Mailing Address - Phone:510-388-2521
Mailing Address - Fax:
Practice Address - Street 1:2099 MT DIABLO BLVD STE 208
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4369
Practice Address - Country:US
Practice Address - Phone:925-272-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist