Provider Demographics
NPI:1710164280
Name:MOSS, DIANE E
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N MONROE ST
Mailing Address - Street 2:TRINITY VICINITY
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1339
Mailing Address - Country:US
Mailing Address - Phone:302-893-1001
Mailing Address - Fax:302-655-2474
Practice Address - Street 1:1004 N MONROE ST
Practice Address - Street 2:TRINITY VICINITY
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1339
Practice Address - Country:US
Practice Address - Phone:302-893-1001
Practice Address - Fax:302-655-2474
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health