Provider Demographics
NPI:1720397912
Name:DIARCHANGEL, GINA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:DIARCHANGEL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 BROAD ST # 1004
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4303
Mailing Address - Country:US
Mailing Address - Phone:732-239-9268
Mailing Address - Fax:
Practice Address - Street 1:157 BROAD ST STE 301
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2013
Practice Address - Country:US
Practice Address - Phone:322-399-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051689001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical