Diane Casanueva Elliott, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PSY003112 Issued in GA

Practice address

277 Pierce Ave
Macon, GA 31204-2419

Phone

(478) 755-0060

Fax

(478) 743-3508

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ingleside Counseling Resources

  • Clinical Psychologist
  • Macon, GA
  • NPI 1952515199
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402617600000",
    "number": "1083768402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 PIERCE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042419",
            "telephone_number": "478-755-0060",
            "fax_number": "478-743-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 PIERCE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042419",
            "telephone_number": "478-755-0060",
            "fax_number": "478-743-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "DIANE",
        "middle_name": "CASANUEVA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2014-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PST000800",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PSY003112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "556624291A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elite Ambulance Transportation
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• Elite Movement Specialists LLC
• Pamela Ellerbee, CRNA
• Jada McNair Elliott, LMSW
• Richard L Elliott, MD
• Ellis W Evans Sr MD Facs PC
• James Stephen Ellis, M.D.
• Linda A Ellis, BA, LMT

• Clinical Child & Adolescent Psychologist in Macon, GA
• Providers in Macon, GA by specialty
• Clinical Child & Adolescent Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.