Basic Information
| Provider Information | |||||||||
| NPI: | 1710181417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRUSZEWSKI | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 PITMAN AVE | ||||||||
| Address2: | |||||||||
| City: | PITMAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092543096 | ||||||||
| FaxNumber: | 8568817614 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 PITMAN AVE | ||||||||
| Address2: | |||||||||
| City: | PITMAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080712621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092543096 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 03/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC04389700 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 228375000 | 01 | NJ | MAGELLAN | OTHER |