Healthcare Provider Details

I. General information

NPI: 1417452434
Provider Name (Legal Business Name): DIANA LOUIS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CUMMINGS CTR
BEVERLY MA
01915-6175
US

IV. Provider business mailing address

29 CLEVELAND AVE
SAUGUS MA
01906-1418
US

V. Phone/Fax

Practice location:
  • Phone: 978-921-1190
  • Fax:
Mailing address:
  • Phone: 407-535-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW126468
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: