Provider Demographics
NPI:1245679372
Name:DIEHL, BRIAN WILLIAM (LICSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:DIEHL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1951
Mailing Address - Country:US
Mailing Address - Phone:617-425-2000
Mailing Address - Fax:617-425-2061
Practice Address - Street 1:1601 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1951
Practice Address - Country:US
Practice Address - Phone:617-425-2000
Practice Address - Fax:617-425-2061
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
1212051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor