Active NPI
Diane Marie Waters, LCSW
- Social Worker
- Riverside, CA
National Provider Identifier
1578775011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LCS 23656
- Practice address
- 19322 Jesse LN
Riverside, CA 92508-5072 - Phone
- (951) 387-4040
- NPI assigned
- May 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LCS 23656 | CA | Primary |
Addresses
Primary practice location
19322 Jesse LN
Riverside, CA 92508-5072
Mailing address
4164 Brockton Ave
Riverside, CA 92501-3400
Phone (951) 683-5193
Other names 1
- Diane Marie Garcia
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 23656 | CA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Talk Therapy Center | Social Worker | Current | Accepting new patients |
Locations
19322 Jesse Ln
Ste 200
Riverside, CA 92508
Phone (951) 387-4040
19322 Jesse Ln
Riverside, CA 92508
Phone (951) 387-4040
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": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687132800000",
"number": "1578775011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4164 BROCKTON AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925013400",
"telephone_number": "951-683-5193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19322 JESSE LN",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925085072",
"telephone_number": "951-387-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "DIANE",
"middle_name": "MARIE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2023-06-19",
"certification_date": "2023-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "LCS 23656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DIANE",
"last_name": "GARCIA",
"middle_name": "MARIE",
"credential": "B.A.",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.