Provider Demographics
NPI:1134246184
Name:VAUGHAN, DIANA K (LCSW-C, LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:CT-6
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-9079
Mailing Address - Fax:504-842-0130
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:CT-6
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-9079
Practice Address - Fax:504-842-0130
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137211041C0700X
LA138161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD615501400Medicaid
MD532201400Medicaid