Provider Demographics
NPI:1083752638
Name:HARRIS, DIANE KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:KATHLEEN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SCARBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-7307
Mailing Address - Country:US
Mailing Address - Phone:503-638-6945
Mailing Address - Fax:
Practice Address - Street 1:11 SCARBOROUGH DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-7307
Practice Address - Country:US
Practice Address - Phone:503-638-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLO9841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical