Provider Demographics
NPI:1467024000
Name:WOOLWORTH, DIANA J (BSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:WOOLWORTH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111149 S 4675 RD
Mailing Address - Street 2:
Mailing Address - City:GANS
Mailing Address - State:OK
Mailing Address - Zip Code:74936-4004
Mailing Address - Country:US
Mailing Address - Phone:918-208-9841
Mailing Address - Fax:
Practice Address - Street 1:4103 S YALE AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6002
Practice Address - Country:US
Practice Address - Phone:918-382-7300
Practice Address - Fax:918-392-3471
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker