Provider Demographics
NPI:1528108354
Name:VINCENZO, DIANA C (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:C
Last Name:VINCENZO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WINSTED RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-2958
Mailing Address - Country:US
Mailing Address - Phone:860-496-3825
Mailing Address - Fax:860-496-3774
Practice Address - Street 1:249 WINSTED RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-2958
Practice Address - Country:US
Practice Address - Phone:860-496-3825
Practice Address - Fax:860-496-3774
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical