| Doctor Name: | DR. DIANE LYNN DUBOW |
| NPI Number: | 1891855268 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PSY12908 |
| Business Practice Address: | 9667 Hwy 29 Lower Lake, CA - 95457 |
| Business Phone Number: | 7079989665 |
| Business Fax Number: | 7079989652 |
| Mailing Address: | Po Box 65, CLEARLAKE OAKS |
| State: | CA |
| Postal Code: | 954230065 |
| Phone Number: | 7079989665 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 06/03/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY12908 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |