Provider Demographics
NPI:1124010574
Name:KEHN, DIANE JOYCE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JOYCE
Last Name:KEHN
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 1:66 SILVERCREST DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3144
Mailing Address - Country:US
Mailing Address - Phone:732-493-5052
Mailing Address - Fax:
Practice Address - Street 1:2 HARTFORD DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4940
Practice Address - Country:US
Practice Address - Phone:732-450-8800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC452601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038510Medicare ID - Type Unspecified
NJP04455Medicare UPIN