Provider Demographics
NPI:1548540677
Name:SHAPIRO, DIANE MANDEL (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MANDEL
Last Name:SHAPIRO
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 1:120 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1527
Mailing Address - Country:US
Mailing Address - Phone:215-350-2212
Mailing Address - Fax:
Practice Address - Street 1:120 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1527
Practice Address - Country:US
Practice Address - Phone:215-350-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0168901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical