Provider Demographics
NPI:1518034461
Name:GALARIS, DIANA D (MSSA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:D
Last Name:GALARIS
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:LOUISE
Other - Last Name:DIMMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA
Mailing Address - Street 1:930 OLD HARMONY ROAD
Mailing Address - Street 2:STE C
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-737-9244
Mailing Address - Fax:302-737-6244
Practice Address - Street 1:930 OLD HARMONY ROAD
Practice Address - Street 2:STE C
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-737-9244
Practice Address - Fax:302-737-6244
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1 00002511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000030415Medicaid
228678OtherMANAGED HEALTH NETWORK
DE1000030416Medicaid
001392OtherVALUE OPTIONS
172864OtherCOMPSYCH
228678OtherMANAGED HEALTH NETWORK
DE1000030415Medicaid
G01168Medicare ID - Type UnspecifiedGROUP