Provider Demographics
NPI:1902942261
Name:MCGREGOR, DIANNE ROBERTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:ROBERTA
Last Name:MCGREGOR
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:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:LAWAI
Mailing Address - State:HI
Mailing Address - Zip Code:96765
Mailing Address - Country:US
Mailing Address - Phone:808-635-6739
Mailing Address - Fax:
Practice Address - Street 1:2975 HALEKO RD
Practice Address - Street 2:SUITE 307
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-245-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW33681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical