MEDICARE: DIANE L FLICK 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	CW016306	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679738421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE L FLICK LCSW

Provider Business Mailing Address
First Line	:	33 FALLS RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-3903
Country	:	US
Telephone Number	:	724-651-7009
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 FALLS RD
Second Line	:
City	:	MERCER
State	:	PA
Zip	:	16137-3903
Country	:	US
Telephone Number	:	724-651-7009
Fax Number	:

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

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	11/17/2023

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