Provider Demographics
NPI:1417974148
Name:SUSSMAN, DIANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:BOYARSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7626 E NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1517
Mailing Address - Country:US
Mailing Address - Phone:480-947-4540
Mailing Address - Fax:
Practice Address - Street 1:7626 E NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1517
Practice Address - Country:US
Practice Address - Phone:480-947-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW105721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ026766OtherVMC BEHAVIORAL HEALTHCARE
AZ352118OtherMANAGED HEALTH NETWORK
AZ7707637OtherAETNA
AZ7707637OtherAETNA
AZ352118OtherMANAGED HEALTH NETWORK