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NPI Code Detail

MEDICARE: DIANE YVONNE DEGRAFFENREID LCSW

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
11041C0700XClinical Social Worker34004695AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122000000373645OTHERINANTHEM PIN
234004695AOTHERINLCSW 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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