Provider Demographics
NPI:1871502898
Name:CASCIOTTI, DIANE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CASCIOTTI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TERRACE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1626
Mailing Address - Country:US
Mailing Address - Phone:410-979-7561
Mailing Address - Fax:
Practice Address - Street 1:101 S MAIN ST STE 307
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3855
Practice Address - Country:US
Practice Address - Phone:410-979-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD063811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQW23Medicare ID - Type UnspecifiedMEDICARE