Provider Demographics
NPI:1467630582
Name:GORSUCH, DIANA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:GORSUCH
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 1:479 S 4TH ST
Mailing Address - Street 2:6A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-5242
Mailing Address - Country:US
Mailing Address - Phone:502-718-1607
Mailing Address - Fax:
Practice Address - Street 1:173 SEARS AVE
Practice Address - Street 2:SUITE 269
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5062
Practice Address - Country:US
Practice Address - Phone:502-718-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY488104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker