Healthcare Provider Details

I. General information

NPI: 1750642328
Provider Name (Legal Business Name): DIANA GAYL DITRAPANI MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEDEE GAYL DITRAPANI MSW, LMSW

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 02/06/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-2379
US

IV. Provider business mailing address

PO BOX 748465
ATLANTA GA
30374-8465
US

V. Phone/Fax

Practice location:
  • Phone: 855-284-7483
  • Fax: 617-807-0958
Mailing address:
  • Phone: 855-284-7483
  • Fax: 617-807-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801046186
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801046186
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: