Provider Demographics
NPI:1629117007
Name:BLUMENTHAL, DIANE M (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:WADE - BLUMENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3285 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1564
Mailing Address - Country:US
Mailing Address - Phone:847-392-4445
Mailing Address - Fax:847-368-1301
Practice Address - Street 1:3285 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1564
Practice Address - Country:US
Practice Address - Phone:847-392-4445
Practice Address - Fax:847-368-1301
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical