Diane Mitzenmacher, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW19655 Issued in CA

Practice address

8300 Utica Ave #155
Rancho Cucuamonga, CA 91730-7605

Phone

(909) 285-5205

Fax

(909) 285-2103

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Diane Mitzenmacher, LCSW Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rancho Cucamonga, CA
  • NPI 1497318943
  NPD (past) Authorized official

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1649366394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 938",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917290938",
            "telephone_number": "909-285-5205",
            "fax_number": "909-285-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 UTICA AVE #155",
            "city": "RANCHO CUCUAMONGA",
            "state": "CA",
            "postal_code": "917307605",
            "telephone_number": "909-285-5205",
            "fax_number": "909-285-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITZENMACHER",
        "first_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS19655",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "BCD#29518",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW19655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Yvonne Collins Licensed Clinical Social Worker PC

• Clinical Social Worker in Rancho Cucuamonga, CA
• Providers in Rancho Cucuamonga, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.