Provider Demographics
NPI:1497143135
Name:SMITH, DIANE MARY
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARY
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2243
Mailing Address - Country:US
Mailing Address - Phone:267-218-3033
Mailing Address - Fax:
Practice Address - Street 1:1759 PALOMINO DR
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2243
Practice Address - Country:US
Practice Address - Phone:267-218-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health