Active NPI
Diane L Hollander, PSYD, BCBA-D
- Clinical Child & Adolescent Psychologist
- Canton, GA
National Provider Identifier
1497196109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PSY003735
- Practice address
- 140 E Marietta St
Canton, GA 30114-3013 - Phone
- (770) 213-3594
- Fax
- (770) 213-3595
- NPI assigned
- Jul 10, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY003735 | GA | Primary |
Addresses
Primary practice location
140 E Marietta St
Canton, GA 30114-3013
Mailing address
140 E Marietta St
Canton, GA 30114-3013
Phone (770) 213-3594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003735 | GA | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia Neurobehavioral Associates, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383264000000",
"number": "1497196109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 E MARIETTA ST",
"city": "CANTON",
"state": "GA",
"postal_code": "301143013",
"telephone_number": "770-213-3594",
"fax_number": "770-213-3595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 E MARIETTA ST",
"city": "CANTON",
"state": "GA",
"postal_code": "301143013",
"telephone_number": "770-213-3594",
"fax_number": "770-213-3595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLANDER",
"first_name": "DIANE",
"middle_name": "L",
"credential": "PSYD, BCBA-D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-10",
"last_updated": "2013-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "PSY003735",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.