Provider Demographics
NPI:1639240427
Name:BANKS, DIANNA F (LICSW)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:F
Last Name:BANKS
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 1:5 SHEPARD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-3417
Mailing Address - Country:US
Mailing Address - Phone:781-588-3880
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA RD
Practice Address - Street 2:STE 12
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1842
Practice Address - Country:US
Practice Address - Phone:781-925-2423
Practice Address - Fax:781-925-2650
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical