Provider Demographics
NPI:1720348584
Name:PAGE, DIANE RENA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RENA
Last Name:PAGE
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 1:409 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9128
Mailing Address - Country:US
Mailing Address - Phone:260-927-8063
Mailing Address - Fax:
Practice Address - Street 1:409 STEEPLECHASE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-9128
Practice Address - Country:US
Practice Address - Phone:260-927-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005439A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical