Organization
DIANE MITZENMACHER, LCSW INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE MITZENMACHER LCSW (PRESIDENT)
(909) 285-5205
Entity
Organization
Contact information
Practice address
8300 UTICA AVE STE 155, RANCHO CUCAMONGA, CA 91730-7605
(909) 285-5205
(909) 989-4648
Mailing address
PO BOX 938, RANCHO CUCAMONGA, CA 91729-0938
(909) 285-5205
(909) 989-4648
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/19/2019
Last updated
04/19/2019
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