Provider Demographics
NPI:1801480306
Name:SPIEKER, DIANA PATRICIA (LAC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:PATRICIA
Last Name:SPIEKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:PATRICIA
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N 6TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6257
Mailing Address - Country:US
Mailing Address - Phone:201-679-1755
Mailing Address - Fax:
Practice Address - Street 1:200 N 6TH ST APT 8
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6257
Practice Address - Country:US
Practice Address - Phone:201-679-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00564200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health