Individual provider Active NPI

Diandra Elise La Croix, LCSW

  • Clinical Social Worker
  • Covina, CA
National Provider Identifier
1528536760
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW101217 Issued in CA
Practice address
4740 N Grand Ave
Covina, CA 91724-2005
Phone
(626) 859-2089
Fax
(626) 859-6537
NPI assigned
Nov 6, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW78774 CA
Clinical Social Worker 1041C0700X LCSW101217 CA Primary

Addresses

Primary practice location

4740 N Grand Ave
Covina, CA 91724-2005

Mailing address

4740 N Grand Ave
Covina, CA 91724-2005
Phone (626) 859-2089

Other names 1

  • Diandra Elise Carstensen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
ASW78774CAMDMental Health Counselor
LCSW101217CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1528536760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917242005",
            "telephone_number": "626-859-2089",
            "fax_number": "626-859-6537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917242005",
            "telephone_number": "626-859-2089",
            "fax_number": "626-859-6537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA CROIX",
        "first_name": "DIANDRA",
        "middle_name": "ELISE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-06",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW78774",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW101217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANDRA",
            "last_name": "CARSTENSEN",
            "middle_name": "ELISE",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.