Provider Demographics
NPI:1366599268
Name:KIEREIN, DIANA S (LICSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:S
Last Name:KIEREIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 WALNUT ST STE 7
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1268
Mailing Address - Country:US
Mailing Address - Phone:617-467-4611
Mailing Address - Fax:509-362-9656
Practice Address - Street 1:1193 WALNUT ST STE 7
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1268
Practice Address - Country:US
Practice Address - Phone:617-467-4611
Practice Address - Fax:509-362-9656
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5466331041C0700X
MA1147521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical