Provider Demographics
NPI:1700012390
Name:CROUSE, DIANE M (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:CROUSE
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 1:200 FENNO ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3934
Mailing Address - Country:US
Mailing Address - Phone:617-472-2262
Mailing Address - Fax:617-740-1850
Practice Address - Street 1:200 FENNO ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-3934
Practice Address - Country:US
Practice Address - Phone:617-472-2262
Practice Address - Fax:617-740-1850
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2156411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical