Provider Demographics
NPI:1710181417
Name:GRUSZEWSKI, DIANE M (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:GRUSZEWSKI
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 1:18 PITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071
Mailing Address - Country:US
Mailing Address - Phone:609-254-3096
Mailing Address - Fax:856-881-7614
Practice Address - Street 1:18 PITMAN AVE
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2621
Practice Address - Country:US
Practice Address - Phone:609-254-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043897001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ228375000OtherMAGELLAN