Provider Demographics
NPI:1093927154
Name:ADLESTEIN, DIANE LIN (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LIN
Last Name:ADLESTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 HERMITAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-203-1011
Mailing Address - Fax:410-938-5072
Practice Address - Street 1:8321 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-203-1011
Practice Address - Fax:410-938-5072
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03286103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical