Provider Demographics
NPI:1134323447
Name:FLANNEGAN, DIANE RICHARDSON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RICHARDSON
Last Name:FLANNEGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1076 RT. 47 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242
Mailing Address - Country:US
Mailing Address - Phone:609-741-6363
Mailing Address - Fax:609-435-5058
Practice Address - Street 1:1076 RT. 47 SOUTH
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242
Practice Address - Country:US
Practice Address - Phone:609-741-6363
Practice Address - Fax:609-435-5058
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045211001041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical