Individual
MS. DIANE ELLABORN
Active
Individual
MS. DIANE ELLABORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
104732
MA
1041C0700X
Clinical Social Worker
Primary
LICSW104732
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000031285
—
MA
01
—
1012390
BEACON
—
01
—
118190
BHN
MA
01
—
140670
VALUE OPTIONS
MA
05
—
1890352
—
MA
01
—
304462
MAGELLAN
MA
01
—
6200635
UBH
MA
01
—
767846
TUFTS
MA
01
—
P03867
BCBS
MA
Enumeration date
10/17/2006
Last updated
09/05/2023
Update your record
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