Diane Jean Ivanov, LCSW
Individual provider Active NPI Clinical Social Worker · Milltown, NJ
NPI 1932183100 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1932183100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 44SC04824800 (NJ)
- Practice address
- 77 N Main St
Ste 4
Milltown, NJ 08850-1521 - Phone
- (718) 496-1149
- NPI assigned
- Dec 1, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R049698-1 | NY | MD | Clinical Social Worker |
| 049698 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
| Quick Mart Pharmacy & Convenience LLC | Past |
Accepting new patients | |
| Richmond Behavioral Associates, LLC | Past |
Accepting new patients | |
| Quick Mart Pharmacy & Convenience LLC | Past | Accepting new patients |
Interoperability endpoints
- dianeivanov@tdh.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SC04824800 | NJ | Yes |
| Clinical Social Worker | 1041C0700X | R049698-1 | NY |
Addresses
Primary practice location
77 N Main St
Ste 4
Milltown, NJ 08850-1521
Mailing address
538 1St Ave
North Brunswick, NJ 08902-3306
Phone (718) 496-1149
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01524574 | Medicaid | NY |
Other names
- Ms. Diane Jean Ruggiero
Other providers in Milltown, NJ
- Linda Ann Harold
- Stephanie Lynn Harris Kuiper
- Alison Henry
- Christina Marie Hill
- Horizon Medical Supplies LLC
- Thomas Gerhard Jacoby
- Janine Essig LPC Lcadc LLC
- Joel R Kates
- Matthew A Kelleman
- Kiara Physical Therapy LLC
All providers in Milltown, NJ · Clinical Social Worker in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.