Provider Demographics
NPI:1619198561
Name:SYLVIA, DIANE S (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E WILMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-234-4670
Mailing Address - Fax:609-788-0515
Practice Address - Street 1:222 NEW RD
Practice Address - Street 2:STE 405
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-234-4670
Practice Address - Fax:609-788-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046095001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ753094Medicare ID - Type Unspecified