Provider Demographics
NPI:1750395141
Name:SAGE, DYANNE M (MSW)
Entity type:Individual
Prefix:MS
First Name:DYANNE
Middle Name:M
Last Name:SAGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:DYANNE
Other - Middle Name:M
Other - Last Name:SEYMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:714 KENT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050
Mailing Address - Country:US
Mailing Address - Phone:717-732-3033
Mailing Address - Fax:717-732-3033
Practice Address - Street 1:714 KENT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050
Practice Address - Country:US
Practice Address - Phone:717-732-3033
Practice Address - Fax:717-732-3033
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0128351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01775402OtherCAPITAL BLUE CROSS
01775402OtherCAPITAL BLUE CROSS