Provider Demographics
NPI:1619216926
Name:HASTINGS, DIANE LEE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LEE
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:ELLEN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 PERSEVERANCE WAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-815-5117
Mailing Address - Fax:508-862-0590
Practice Address - Street 1:60 PERSEVERANCE WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-815-5117
Practice Address - Fax:508-862-0590
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1159731041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical