Provider Demographics
NPI:1861734923
Name:OLDENBURG-DURECKA, DIANE L (MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:L
Last Name:OLDENBURG-DURECKA
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 VAN NESS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2664
Mailing Address - Country:US
Mailing Address - Phone:248-798-1146
Mailing Address - Fax:
Practice Address - Street 1:29260 FRANKLIN RD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1196
Practice Address - Country:US
Practice Address - Phone:248-798-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006477103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical