Provider Demographics
NPI:1285386896
Name:POLLUTRO, DIANE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:POLLUTRO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 DAYCOETON PL
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6326
Mailing Address - Country:US
Mailing Address - Phone:860-626-1112
Mailing Address - Fax:860-626-1118
Practice Address - Street 1:43 DAYCOETON PL
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6326
Practice Address - Country:US
Practice Address - Phone:860-626-1112
Practice Address - Fax:860-626-1118
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty