Provider Demographics
NPI:1992046940
Name:ISLES, DIANE (MA)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:ISLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:GIANNINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:7 LINCOLN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3021
Mailing Address - Country:US
Mailing Address - Phone:781-328-1904
Mailing Address - Fax:781-396-1439
Practice Address - Street 1:7 LINCOLN ST STE 216
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3021
Practice Address - Country:US
Practice Address - Phone:781-328-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10316101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty