Healthcare Provider Details

I. General information

NPI: 1164616256
Provider Name (Legal Business Name): DIANE RITA HULL LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DIANE RITA ROBERTS

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9077 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

9077 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-5586
  • Fax: 301-891-5596
Mailing address:
  • Phone: 301-891-5586
  • Fax: 301-891-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04600
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: