Provider Demographics
NPI:1346441052
Name:BROWN, DIANE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:BROWN
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 1:1818 S 10TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4880
Mailing Address - Country:US
Mailing Address - Phone:208-459-4412
Mailing Address - Fax:208-459-7296
Practice Address - Street 1:1818 S 10TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4880
Practice Address - Country:US
Practice Address - Phone:208-459-4412
Practice Address - Fax:208-459-7296
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-9681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDL5944OtherBLUE CROSS
ID000010017051OtherBLUE SHIELD