Individual
MS. DIANE JOAN DMYTRYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
66 MARSTON ST, MEDFORD, MA 02155-4469
(781) 395-5724
(484) 450-4144
Mailing address
66 MARSTON ST, MEDFORD, MA 02155-4469
(781) 395-5724
(484) 450-4144
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1015702
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P04659
BLUE CROSS BLUE SHIELD
MA
Enumeration date
07/16/2007
Last updated
07/16/2007
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