Provider Demographics
NPI:1538646500
Name:MAROLLA, DIANE LYNN (DIANE)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:MAROLLA
Suffix:
Gender:F
Credentials:DIANE
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LYNN
Other - Last Name:GIARRUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DIANE
Mailing Address - Street 1:1075 SMITH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1598 S COUNTY TRL STE 102
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1762
Practice Address - Country:US
Practice Address - Phone:401-369-9224
Practice Address - Fax:401-369-9275
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
RIISW015451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical