Provider Demographics
NPI:1861830317
Name:DIANE BAUER, LCSW, LLC
Entity Type:Organization
Organization Name:DIANE BAUER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-896-5140
Mailing Address - Street 1:1817 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3914
Mailing Address - Country:US
Mailing Address - Phone:412-896-5140
Mailing Address - Fax:412-896-5141
Practice Address - Street 1:1817 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-3914
Practice Address - Country:US
Practice Address - Phone:412-896-5140
Practice Address - Fax:412-896-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003959101YP2500X
PAPC001177101YP2500X
PACW0165571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2153170OtherHIGHMARK/ BLUE CROSS BLUE SHIELD
TX9091928OtherAETNA
CA512156OtherTRICARE