Provider Demographics
NPI:1053482281
Name:HARTH, DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HARTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3936
Mailing Address - Country:US
Mailing Address - Phone:201-445-3883
Mailing Address - Fax:201-684-0941
Practice Address - Street 1:1172 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3936
Practice Address - Country:US
Practice Address - Phone:201-445-3883
Practice Address - Fax:201-684-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051565001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085657Medicare ID - Type Unspecified