Provider Demographics
NPI:1952407959
Name:SKLAR, DIANA LYNN I (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LYNN
Last Name:SKLAR
Suffix:I
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 1:3 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1701
Mailing Address - Country:US
Mailing Address - Phone:781-762-4799
Mailing Address - Fax:781-769-5356
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-762-4799
Practice Address - Fax:781-769-5356
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10203101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08249OtherBCBS
MA1853660Medicaid
MAP21494Medicare ID - Type Unspecified