Provider Demographics
NPI:1700909579
Name:CRIVELLI DIAMOND, PAULA CECELIA (LICSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:CECELIA
Last Name:CRIVELLI DIAMOND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 28TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4107
Mailing Address - Country:US
Mailing Address - Phone:202-251-8682
Mailing Address - Fax:
Practice Address - Street 1:3400 MLK JR AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1542
Practice Address - Country:US
Practice Address - Phone:202-724-7666
Practice Address - Fax:202-724-7846
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500781051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
018003C58Medicare ID - Type Unspecified