Provider Demographics
NPI:1750642328
Name:DITRAPANI, DIANA GAYL (MSW, LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:GAYL
Last Name:DITRAPANI
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:MRS
Other - First Name:DEEDEE
Other - Middle Name:GAYL
Other - Last Name:DITRAPANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LMSW
Mailing Address - Street 1:PO BOX 748465
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8465
Mailing Address - Country:US
Mailing Address - Phone:855-284-7483
Mailing Address - Fax:617-807-0958
Practice Address - Street 1:710 KENMOOR AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2379
Practice Address - Country:US
Practice Address - Phone:855-284-7483
Practice Address - Fax:617-807-0958
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010461861041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical