Provider Demographics
NPI:1194833905
Name:LIVI, DIANA TAYLOR (LCSW C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:TAYLOR
Last Name:LIVI
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OAK CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5842
Mailing Address - Country:US
Mailing Address - Phone:410-869-0720
Mailing Address - Fax:410-869-0720
Practice Address - Street 1:6525 NORTH CHARLES STREET
Practice Address - Street 2:SUITE 136 THE GIBSON BUILDING
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6872
Practice Address - Country:US
Practice Address - Phone:443-838-6075
Practice Address - Fax:410-869-0720
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD61711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQQ39DTOtherCAREFIRST BC AND BS
QQ39Medicare ID - Type Unspecified