Provider Demographics
NPI:1255488037
Name:NASH, DIANE DE LA RIVA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:DE LA RIVA
Last Name:NASH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4322
Mailing Address - Country:US
Mailing Address - Phone:508-747-2718
Mailing Address - Fax:
Practice Address - Street 1:323 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4322
Practice Address - Country:US
Practice Address - Phone:508-747-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1032208104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADEP22828Medicare ID - Type Unspecified