Provider Demographics
NPI:1962499210
Name:DENNISON, DIANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:DENNISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BOXELDER LN
Mailing Address - Street 2:TREE LANE TERRACE
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3039
Mailing Address - Country:US
Mailing Address - Phone:302-328-7939
Mailing Address - Fax:
Practice Address - Street 1:405 FOULK RD
Practice Address - Street 2:SOAR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3809
Practice Address - Country:US
Practice Address - Phone:302-655-9049
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0000751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health