Provider Demographics
NPI:1609936939
Name:STANLEY, DIANE (LCSW, LCADC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TRENT RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1974
Mailing Address - Country:US
Mailing Address - Phone:908-334-7206
Mailing Address - Fax:888-974-1397
Practice Address - Street 1:22 TRENT RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-1974
Practice Address - Country:US
Practice Address - Phone:908-334-7206
Practice Address - Fax:888-974-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00099300101YA0400X
NJ44SC047821001041C0700X
NJ1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0050156Medicaid