Dr. Diane Casanueva Elliott
Clinical Child & Adolescent Psychologist
277 Pierce Ave
Macon
, Georgia 31204-2419
Dr. Diane Casanueva Elliott
Clinical Child & Adolescent Psychologist
277 Pierce Ave
Macon
, Georgia 31204-2419
(478) 743-3508
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About
Features
Specialties
- Clinical Child & Adolescent Psychologist
Languages spoken
- English
Location
First Address
- Dr. Diane Casanueva Elliott
- 277 Pierce Ave
- Macon, GA
- Zip : 31204-2419
- Fax : (478) 743-3508
- Phone : (478) 755-0060
Second Address
- Dr. Diane Casanueva Elliott
- 277 Pierce Ave
- Macon, GA
- Zip : 31204-2419
- Fax : (478) 743-3508
- Phone : (478) 755-0060
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Is Dr. Diane Casanueva Elliott a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 103TC2200X | Clinical Child & Adolescent Psychologist | PST000800 | GA |
| Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY003112 | GA |
National Provider Identifier
| NPI | 1083768402 |
|---|---|
| Provider Name | Dr. Diane Casanueva Elliott |
| First Address | Macon, GA 31204-2419 |
| Second Address | Macon, GA 31204-2419 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 23/01/2007 |
| Last Update Date | 13/06/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 556624291A | (05) | GA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.