Provider Demographics
NPI:1982699377
Name:MCQUILLEN, DIANE J (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:J
Last Name:MCQUILLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2301
Mailing Address - Country:US
Mailing Address - Phone:724-775-9150
Mailing Address - Fax:724-775-9153
Practice Address - Street 1:219 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2301
Practice Address - Country:US
Practice Address - Phone:724-775-9150
Practice Address - Fax:724-775-9153
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW003015E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA678746Medicare ID - Type Unspecified