Provider Demographics
NPI:1932117231
Name:SMITH, DIANE (LMSW, LAPSW, ACSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW, LAPSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 EASTWICK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-2311
Mailing Address - Country:US
Mailing Address - Phone:317-598-8826
Mailing Address - Fax:317-598-8841
Practice Address - Street 1:7151 EASTWICK LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-2311
Practice Address - Country:US
Practice Address - Phone:317-598-8826
Practice Address - Fax:317-598-8841
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNASW0000000096104100000X
TNLSW0000005931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker