Active NPI
Diane Malone Kudolo, LPC, CART
- Counselor
- San Antonio, TX
National Provider Identifier
1922398346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 65512
- Practice address
- 207 N Comal
San Antonio, TX 78207 - Phone
- (210) 213-5780
- NPI assigned
- Apr 19, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 65512 | TX | Primary |
Addresses
Primary practice location
207 N Comal
San Antonio, TX 78207
Mailing address
7305 Sunscape Way
San Antonio, TX 78204
Phone (210) 213-5780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240117004017 | TX | Practitioner - Mental Health Counselor | 6002170008 | Practice locations: San Antonio, TX |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65512 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303171200000",
"number": "1922398346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7305 SUNSCAPE WAY",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78204",
"telephone_number": "210-213-5780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 N COMAL",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78207",
"telephone_number": "210-213-5780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUDOLO",
"first_name": "DIANE",
"middle_name": "MALONE",
"credential": "LPC, CART",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-19",
"last_updated": "2011-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "65512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; 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.