Provider Demographics
NPI:1174663546
Name:FERRIS, DIANE JEAN (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JEAN
Last Name:FERRIS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 ROUTE 52
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3533
Mailing Address - Country:US
Mailing Address - Phone:845-797-2228
Mailing Address - Fax:
Practice Address - Street 1:DIANE J. FERRIS, LCSW-R
Practice Address - Street 2:1989 ROUTE 52, SUITE 6
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533
Practice Address - Country:US
Practice Address - Phone:845-797-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060670-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical