Provider Demographics
NPI:1669705059
Name:PRADARELLI, DIANE L (MSW, APSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:PRADARELLI
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 PROMISE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8981
Mailing Address - Country:US
Mailing Address - Phone:057-181-0956
Mailing Address - Fax:
Practice Address - Street 1:2165 PROMISE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8981
Practice Address - Country:US
Practice Address - Phone:605-718-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128504-121101Y00000X, 104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor