Provider Demographics
NPI:1144496746
Name:CLANCY, DIANE MARIE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:CLANCY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BARONY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6117
Mailing Address - Country:US
Mailing Address - Phone:301-299-1629
Mailing Address - Fax:815-717-9837
Practice Address - Street 1:171 BARONY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6117
Practice Address - Country:US
Practice Address - Phone:904-248-0035
Practice Address - Fax:815-717-9837
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW91961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical