Individual
DIANE M PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
180 OLD TAPPAN RD STE 9, OLD TAPPAN, NJ 07675-7048
(929) 376-8868
Mailing address
180 OLD TAPPAN RD STE 9, OLD TAPPAN, NJ 07675-7048
(929) 376-8868
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SL06829700
NJ
Other
Enumeration date
08/11/2022
Last updated
02/06/2025
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