Provider Demographics
NPI:1891042560
Name:HEYWARD-BOWDEN, DIANA L (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:HEYWARD-BOWDEN
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3725
Mailing Address - Country:US
Mailing Address - Phone:908-208-1371
Mailing Address - Fax:973-839-3653
Practice Address - Street 1:2130 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3725
Practice Address - Country:US
Practice Address - Phone:908-208-1371
Practice Address - Fax:973-839-3653
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00174500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker