Provider Demographics
NPI:1205995149
Name:LAKS, DIANE SUSAN (MSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SUSAN
Last Name:LAKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-1901
Mailing Address - Country:US
Mailing Address - Phone:973-839-2550
Mailing Address - Fax:973-686-2240
Practice Address - Street 1:1259 ROUTE 46
Practice Address - Street 2:100A BUILDING 2
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4913
Practice Address - Country:US
Practice Address - Phone:973-316-9333
Practice Address - Fax:973-839-3736
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC001321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical