Provider Demographics
NPI:1174609838
Name:BLOOD, DIANA BARNES (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:BARNES
Last Name:BLOOD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-3800
Mailing Address - Country:US
Mailing Address - Phone:781-259-0166
Mailing Address - Fax:781-259-0610
Practice Address - Street 1:104 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-3800
Practice Address - Country:US
Practice Address - Phone:781-259-0166
Practice Address - Fax:781-259-0610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100430104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02841OtherBLUE CROSS/BLUE SHIELD
MAP02841OtherBLUE CROSS/BLUE SHIELD