Healthcare Provider Details

I. General information

NPI: 1750347621
Provider Name (Legal Business Name): DIANE K ADELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 SOUTH MAIN STREET
COLCHESTER CT
06415
US

IV. Provider business mailing address

244 SOUTH MAIN STREET
COLCHESTER CT
06415
US

V. Phone/Fax

Practice location:
  • Phone: 860-338-3324
  • Fax:
Mailing address:
  • Phone: 860-338-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000734
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000714
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: