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General NPI Number Information
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NPI Number | 1114250560
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Entity Type | Individual
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Provider Name | DIANA MAUREEN BYRON LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 901 S HUNTINGTON ST
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City | SYRACUSE
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State | IN
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Zip | 46567-1923
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Country | US
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Telephone | 574-457-4400
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Fax | 574-269-0597
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Provider Business Mailing Address
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Address Line | 850 N HARRISON ST ATTN: ANNE LAWSON
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City | WARSAW
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State | IN
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Zip | 46580-3163
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Country | US
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Telephone | 574-267-7169
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Fax | 574-269-0597
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801092848
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005816A
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License Number State | IN
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