Healthcare Provider Details

I. General information

NPI: 1245679372
Provider Name (Legal Business Name): BRIAN WILLIAM DIEHL LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

IV. Provider business mailing address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2000
  • Fax: 617-425-2061
Mailing address:
  • Phone: 617-425-2000
  • Fax: 617-425-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121205
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: