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NPI Code Detail

MEDICARE: DIANE STANLEY LCSW LLC

MEDICARE: DIANE STANLEY LCSW LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)LCSW 44SC04782100NJ

General Provider Information

NPI Number : 1407071673
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIANE STANLEY LCSW LLC
Provider Business Mailing Address
First Line : 22 TRENT RD
Second Line :
City : MONROE
State : NJ
Zip : 08831-1974
Country : US
Telephone Number : 908-334-7206
Fax Number : 888-974-1397
Provider Business Practice Location Address
First Line : 20 COMMERCE DR STE 135
Second Line :
City : CRANFORD
State : NJ
Zip : 07016-3614
Country : US
Telephone Number : 908-334-7206
Fax Number : 888-974-1397
Authorized Official
Title or Position : OWNER
Name : DIANE STANLEY
Credential : LCSW
Telephone Number : 908-334-7206
Provider Enumeration Date : 04/14/2007
Last Update Date : 11/12/2019

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