Provider Demographics
NPI:1922059880
Name:MEYERS, DIANE ELIZABETH (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:MEYERS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:PETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:17 STEVENS STREET
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-0815
Mailing Address - Country:US
Mailing Address - Phone:603-759-2165
Mailing Address - Fax:508-852-2231
Practice Address - Street 1:17 STEVENS STREET
Practice Address - Street 2:SUITE 1-3
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-0815
Practice Address - Country:US
Practice Address - Phone:603-759-2165
Practice Address - Fax:508-852-2231
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113657104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP24099Medicare UPIN