Provider Demographics
NPI:1821581018
Name:JOSEPH, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:JOSEPH
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 1:50 REDFIELD ST STE 306
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3653
Mailing Address - Country:US
Mailing Address - Phone:617-981-2549
Mailing Address - Fax:617-469-8600
Practice Address - Street 1:31 WOODRUFF WAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-2610
Practice Address - Country:US
Practice Address - Phone:617-981-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator