Provider Demographics
NPI:1538159462
Name:BOYD, DIANA E (LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:E
Last Name:BOYD
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 1:64 E CALLE DE ARCOS
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3120
Mailing Address - Country:US
Mailing Address - Phone:480-820-4186
Mailing Address - Fax:
Practice Address - Street 1:500 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3599
Practice Address - Country:US
Practice Address - Phone:480-752-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-112891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical