Provider Demographics
NPI:1134799208
Name:DASRAJ, DIANA (MA, LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DASRAJ
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 LAKE WORTH RD
Mailing Address - Street 2:SUITE 213-214
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:561-444-2351
Mailing Address - Fax:561-469-7089
Practice Address - Street 1:6801 LAKE WORTH RD
Practice Address - Street 2:SUITE 213-214
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-444-2351
Practice Address - Fax:561-469-7089
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091518-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical