Healthcare Provider Details

I. General information

NPI: 1033724489
Provider Name (Legal Business Name): DIANE COSTELLO SCHWERDT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 ROSEMARY ST UNIT K
NEEDHAM MA
02494-3238
US

IV. Provider business mailing address

7 ARMEN WAY
NEEDHAM MA
02492-1900
US

V. Phone/Fax

Practice location:
  • Phone: 617-444-7186
  • Fax:
Mailing address:
  • Phone: 617-957-4279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122951
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: