MS. DIANE ELIZABETH SHROCK (NPI# 1861693574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861693574 |
| Entity Type | Individual |
| Full Name | MS. DIANE ELIZABETH SHROCK |
| Credential | LMFT |
| Practice Address |
320 Western Ave Petaluma CA 94952-2919 |
| Mailing Address |
2817 Claremont Dr Santa Rosa CA 95405-6868 |
| Practice Telephone | 7075667712 |
| Practice Fax Number | 7078293170 |
| Mailing Telephone | 7075667123 |
| Mailing Fax Number | 7078293170 |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | MFC33832 | CA | Behavioral Health & Social Service Providers |
| Street Address |
320 WESTERN AVE |
| City | PETALUMA |
| State | CA |
| Zip Code | 94952-2919 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568506319 | Barbara Finley Badham | Psychologist | 320 Western Ave, Petaluma, CA 94952 | 2007-02-16 |
| 1851750624 | Veronica Alyse Benjamin | Dietitian, Registered | 320 Western Ave, Petaluma, CA 94952-2919 | 2016-02-22 |
| 1730390139 | Michelle Elena Minero | Marriage & Family Therapist | 320 Western Ave, Petaluma, CA 94952-2919 | 2007-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114587680 | Benjamin R Idarius | Behavior Technician | 101 H St. Ste. L, Petaluma, CA 94952 | 2019-06-17 |
| 1518457159 | Kyleen Joan Romero | Behavioral Analyst | 25 Graylawn Ave, Petaluma, CA 94952 | 2018-05-17 |
| 1437647526 | John Scruggs | Behavior Technician | 301 H St. Suit L, Petaluma, CA 94952 | 2018-04-25 |
| 1811404684 | Brief and Strategic Counseling Service | Counselor | 843 Chardonnay Cir., Petaluma, CA 94952 | 2018-01-03 |
| 1730638396 | Jennifer Lee Sloan | Acupuncturist | 517 Hayes Lane, Petaluma, CA 94952 | 2016-09-23 |
| 1982057295 | Elene Hwa-yihg Chung | Acupuncturist | 130 Graylawn Ave.,#f, Petaluma, CA 94952 | 2016-07-21 |
| 1457773624 | Lisa Hirsch Cordeiro | Marriage & Family Therapist | 700 Sixth Street, Petaluma, CA 94952 | 2014-01-07 |
| 1811271075 | Jacques Philippe Archer | Massage Therapist | 131b Kentucky St., Petaluma, CA 94952 | 2011-10-06 |
| 1477841609 | Karna Licia Dawson | Social Worker | 205 Keller St., Petaluma, CA 94952 | 2011-07-21 |
| 1497051783 | Melissa Beth Wilson | Acupuncturist | 155a Kentucky Street, Petaluma, CA 94952 | 2011-02-03 |
| Find all providers in zip 94952 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326607201 | Making Magic Happen - People Helping People, Inc. | Marriage & Family Therapist | 1318 Redwood Way, Suite 260, Petaluma, CA 94954 | 2019-06-13 |
| 1184106783 | Martin Graff | Marriage & Family Therapist | 855 Lakeville St Ste 108, Petaluma, CA 94952-7328 | 2018-08-30 |
| 1104315845 | Nancy June Goldstein | Marriage & Family Therapist | 134 Grevillia Dr, Petaluma, CA 94952-6110 | 2018-05-08 |
| 1588168405 | Christopher John Ranney | Marriage & Family Therapist | 10 4th St, Petaluma, CA 94952-3004 | 2018-03-23 |
| 1558803288 | Emily Mann | Marriage & Family Therapist | 141 F St, Petaluma, CA 94952-4236 | 2016-11-11 |
| 1932641198 | Heather Sutherland | Marriage & Family Therapist | 1104 Whippoorwill Ct, Petaluma, CA 94954-1815 | 2016-11-04 |
| 1568911964 | Petaluma Family Therapy | Marriage & Family Therapist | 405 E D St Ste 105, Petaluma, CA 94952-3173 | 2016-09-26 |
| 1568824670 | Donald W Waxman | Marriage & Family Therapist | 6 C St, Petaluma, CA 94952-3025 | 2016-03-28 |
| 1245605450 | Rachael Newman | Marriage & Family Therapist | 47 6th St Ste 200, Petaluma, CA 94952-3092 | 2015-12-14 |
| 1477925766 | Tonia Sassi | Marriage & Family Therapist | 174 Windsor Dr, Petaluma, CA 94952-7504 | 2015-10-26 |
| Find all providers in PETALUMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.