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General NPI Number Information
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NPI Number | 1720102239
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Entity Type | Individual
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Provider Name | DIANE STARK SUDA MSW
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 10 FRANKLIN TURNPIKE SECOND FLOOR
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City | WALDWICK
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State | NJ
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Zip | 07463
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Country | US
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Telephone | 201-612-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 19 SHADYSIDE DRIVE
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City | WYCKOFF
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State | NJ
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Zip | 07481
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Country | US
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Telephone | 201-891-5148
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Fax |
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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 | 44SC00190100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR03997100
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License Number State | NJ
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