Provider Demographics
NPI:1679696520
Name:MAYER, DIANE PETERS (LSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:PETERS
Last Name:MAYER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7651
Mailing Address - Country:US
Mailing Address - Phone:610-253-7056
Mailing Address - Fax:
Practice Address - Street 1:300 SPRUCE ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3818
Practice Address - Country:US
Practice Address - Phone:215-348-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW006985L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker