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General NPI Number Information
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NPI Number | 1083780779
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Entity Type | Individual
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Provider Name | DIANE PISANO LCSW C
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 14300 GALLANT FOX LN SUITE 107
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City | BOWIE
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State | MD
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Zip | 20715-4003
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Country | US
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Telephone | 301-805-5124
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Fax | 301-805-1351
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Provider Business Mailing Address
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Address Line | 3715 IVY HILL LANE
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City | BOWIE
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State | MD
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Zip | 20715
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Country | US
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Telephone | 301-805-5124
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Fax | 301-805-1351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | O6414
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License Number State | MD
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