Provider Demographics
NPI:1154415966
Name:TRUE, DIANE JEANETTE (LICENSED INDEPENDENT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:JEANETTE
Last Name:TRUE
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:JEANETTE
Other - Last Name:MALOOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 1902
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 CHESTNUT STREET
Practice Address - Street 2:SUITE 2F
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-475-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102148104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
012510OtherVALUE OPTIONS
MA721589OtherTUFTS HEALTH CARE
P02934OtherBCBS OF MA
MA051649000OtherMAGELLAN PIN
MA1013270OtherBEACON HEALTH STRATEGIES
MA100515OtherMAGELLAN PIN
P02934OtherBCBS OF MA