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General NPI Number Information
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NPI Number | 1720397912
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Entity Type | Individual
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Provider Name | GINA MARIE DIARCHANGEL LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 157 BROAD ST STE 301
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City | RED BANK
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State | NJ
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Zip | 07701-2013
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Country | US
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Telephone | 322-399-2687
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 BROAD ST # 1004
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4303
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Country | US
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Telephone | 732-239-9268
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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 | 44SC05168900
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License Number State | NJ
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