Individual
MS. DIANE MARIE GORMAN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2504 WASHINGTON ST, WAUKEGAN, IL 60085-4983
(847) 692-6495
Mailing address
57 SUMMIT AVE, PARK RIDGE, IL 60068-4103
(847) 692-6495
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
IL
Other
Enumeration date
03/07/2008
Last updated
03/07/2008
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