Provider Demographics
NPI:1811097421
Name:FORLENZA, DIANA LYNN (LICSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LYNN
Last Name:FORLENZA
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 1:14566 86TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4770
Mailing Address - Country:US
Mailing Address - Phone:425-318-4002
Mailing Address - Fax:
Practice Address - Street 1:10512 NE 68TH ST
Practice Address - Street 2:SUITE C-202
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7002
Practice Address - Country:US
Practice Address - Phone:206-554-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000091211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical