Provider Demographics
NPI:1477579340
Name:PERRY-ADLER, DIANE (LIC PSYCHOLOGICAL PR)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:PERRY-ADLER
Suffix:
Gender:F
Credentials:LIC PSYCHOLOGICAL PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:130 SOUTHERN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3223
Mailing Address - Country:US
Mailing Address - Phone:606-679-4782
Mailing Address - Fax:606-678-5296
Practice Address - Street 1:200 E FRAZIER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1915
Practice Address - Country:US
Practice Address - Phone:270-384-4710
Practice Address - Fax:270-384-4820
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY114174103TC1900X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0500007Medicare PIN
KY0500405Medicare PIN