Provider Demographics
NPI:1649472424
Name:KOURY ALESSI, DIANE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:KOURY ALESSI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 KINGS HWY N
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1912
Mailing Address - Country:US
Mailing Address - Phone:856-482-6993
Mailing Address - Fax:856-424-5158
Practice Address - Street 1:1101 KINGS HWY N
Practice Address - Street 2:SUITE 203
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1912
Practice Address - Country:US
Practice Address - Phone:856-482-6993
Practice Address - Fax:856-424-5158
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010172001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical