Provider Demographics
NPI:1285965913
Name:DEMETRI, DIANA LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:DEMETRI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 STOW RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1828
Mailing Address - Country:US
Mailing Address - Phone:978-423-9448
Mailing Address - Fax:
Practice Address - Street 1:134 STOW RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1828
Practice Address - Country:US
Practice Address - Phone:978-423-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical