Provider Demographics
NPI:1508911272
Name:SHARPER, DIANE MARIE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:SHARPER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:S
Other - Last Name:SHARPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:3005 JAMES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2533
Mailing Address - Country:US
Mailing Address - Phone:612-871-4250
Mailing Address - Fax:612-823-1820
Practice Address - Street 1:3005 JAMES AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2533
Practice Address - Country:US
Practice Address - Phone:612-871-4250
Practice Address - Fax:612-823-1820
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6G028SHOtherBLUECROSSBLUESHIELD
MN18469OtherHEALTH PARTNERS
MN6200913OtherUNITEDBEHAVIORALHEALTH
MN6200913OtherMEDICA