Provider Demographics
NPI:1407907579
Name:DEGRAFFENREID, DIANE YVONNE (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:YVONNE
Last Name:DEGRAFFENREID
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:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-492-6498
Practice Address - Street 1:1500 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2059
Practice Address - Country:US
Practice Address - Phone:812-475-1390
Practice Address - Fax:812-475-1398
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004695A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22000000373645OtherANTHEM PIN
IN34004695AOtherLCSW STATE LICENSE