MEDICARE: DIANE YVONNE DEGRAFFENREID LCSW

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
1	1041C0700X	Clinical Social Worker	34004695A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22000000373645	OTHER	IN	ANTHEM PIN
2	34004695A	OTHER	IN	LCSW STATE LICENSE

General Provider Information

NPI Number	:	1407907579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE YVONNE DEGRAFFENREID LCSW

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47731-3276
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-492-6498

Provider Business Practice Location Address
First Line	:	1500 WASHINGTON AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-2059
Country	:	US
Telephone Number	:	812-475-1390
Fax Number	:	812-475-1398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	06/06/2023

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