Provider Demographics
NPI:1932283587
Name:DURR, DIANA MARIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIE
Last Name:DURR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:52 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609
Mailing Address - Country:US
Mailing Address - Phone:508-752-5191
Mailing Address - Fax:508-792-1514
Practice Address - Street 1:19 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-0342
Practice Address - Fax:508-792-1514
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030803LLICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23960Medicare ID - Type Unspecified