Provider Demographics
NPI:1194935940
Name:YOUNG, DIANE MARIE (LCSW, LADC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREENHILL TER
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1513
Mailing Address - Country:US
Mailing Address - Phone:203-288-3344
Mailing Address - Fax:
Practice Address - Street 1:352 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3108
Practice Address - Country:US
Practice Address - Phone:203-781-4600
Practice Address - Fax:203-781-4624
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000542101YA0400X
CT0052271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300000542CT01OtherANTHEM BCBS
CT022672OtherVMC AFFILIATE
CT500000315Medicaid
CT140005227CT01OtherANTHEM BCBS
CT303733OtherMHN
CT004082286Medicaid
CT008022626Medicaid
CT476270000OtherMAGELLAN
CT513954OtherVALUE OPTIONS
CT7944589OtherAETNA
CT004235083Medicaid
CT513954OtherVALUE OPTIONS
CTD400369107Medicare PIN