Healthcare Provider Details

I. General information

NPI: 1427538321
Provider Name (Legal Business Name): DIANE J ZIPOLI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 BAY STATE RD
BOSTON MA
02215-1403
US

IV. Provider business mailing address

264 BAY STATE RD
BOSTON MA
02215-1403
US

V. Phone/Fax

Practice location:
  • Phone: 617-838-0109
  • Fax:
Mailing address:
  • Phone: 617-838-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111008
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: