Provider Demographics
NPI:1902984040
Name:BOAR, DIANE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:BOAR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W END AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7810
Mailing Address - Country:US
Mailing Address - Phone:908-616-5550
Mailing Address - Fax:347-778-0718
Practice Address - Street 1:33 W END AVE APT 3G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7810
Practice Address - Country:US
Practice Address - Phone:908-616-5550
Practice Address - Fax:732-264-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY838081041C0700X
NY083808-11041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83808OtherLICENSE