Individual provider Active NPI

Diane Travers, LCSW

  • Clinical Social Worker
  • Montclair, NJ
National Provider Identifier
1184919342
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC00747300 Issued in NJ
Practice address
33 S Fullerton Ave
Montclair, NJ 07042-3358
Phone
(973) 509-9777
Fax
(973) 233-8299
NPI assigned
Jun 16, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC00747300 NJ Primary

Addresses

Primary practice location

33 S Fullerton Ave
Montclair, NJ 07042-3358

Mailing address

33 S Fullerton Ave
Montclair, NJ 07042-3358
Phone (973) 509-9777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
44SC00747300NJMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308182400000",
    "number": "1184919342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 S FULLERTON AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423358",
            "telephone_number": "973-509-9777",
            "fax_number": "973-233-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 S FULLERTON AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423358",
            "telephone_number": "973-509-9777",
            "fax_number": "973-233-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVERS",
        "first_name": "DIANE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC00747300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.