Provider Demographics
NPI:1598334716
Name:BARI, DIANNE R (LICSW)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:R
Last Name:BARI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MARQUIS RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3144
Mailing Address - Country:US
Mailing Address - Phone:612-760-6421
Mailing Address - Fax:
Practice Address - Street 1:2120 MARQUIS RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-3144
Practice Address - Country:US
Practice Address - Phone:612-760-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN270081041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical