Provider Demographics
NPI:1972072296
Name:FERRARI, DIANE M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:FERRARI
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:MILTON RESIDENTS FUND
Mailing Address - Street 2:535 CANTON AVE.
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-696-1214
Mailing Address - Fax:
Practice Address - Street 1:MILTON RESIDENTS FUND
Practice Address - Street 2:535 CANTON AVE.
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-696-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104910104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker