Basic Information
| Provider Information | |||||||||
| NPI: | 1578831830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIWEK | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | LAMPE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9030 ROUTE 108 STE A | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451990 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9030 ROUTE 108 STE A | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107401901 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2011 | ||||||||
| LastUpdateDate: | 09/26/2014 | ||||||||
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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 | 44SC05577900 | NJ | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 13985 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.