Provider Demographics
NPI:1629432166
Name:SPEZIA, DIANE MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:SPEZIA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:MI
Mailing Address - Zip Code:48367-1711
Mailing Address - Country:US
Mailing Address - Phone:586-243-1029
Mailing Address - Fax:
Practice Address - Street 1:34474 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-2003
Practice Address - Country:US
Practice Address - Phone:586-996-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011060871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical