Provider Demographics
NPI:1114250560
Name:BYRON, DIANA MAUREEN (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MAUREEN
Last Name:BYRON
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 1:850 N HARRISON ST
Mailing Address - Street 2:ATTN: ANNE LAWSON
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3163
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-0597
Practice Address - Street 1:901 S HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1923
Practice Address - Country:US
Practice Address - Phone:574-457-4400
Practice Address - Fax:574-269-0597
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010928481041C0700X
IN34005816A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical