Provider Demographics
NPI:1558546465
Name:FRATES, DIANA LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LYNN
Last Name:FRATES
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 1:3243 NE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2431
Mailing Address - Country:US
Mailing Address - Phone:530-864-4115
Mailing Address - Fax:530-864-4115
Practice Address - Street 1:3243 NE 52ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2431
Practice Address - Country:US
Practice Address - Phone:530-864-4115
Practice Address - Fax:530-534-3820
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268571041C0700X
WA609532581041C0700X
ORL83761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical