Provider Demographics
NPI:1710666185
Name:ASHOURI, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ASHOURI
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 1:194 SAYRE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5802
Mailing Address - Country:US
Mailing Address - Phone:786-208-9675
Mailing Address - Fax:
Practice Address - Street 1:659 EAGLE ROCK AVE STE 4
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2138
Practice Address - Country:US
Practice Address - Phone:855-274-3395
Practice Address - Fax:469-519-1448
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00608900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health