Healthcare Provider Details

I. General information

NPI: 1457620825
Provider Name (Legal Business Name): DIANA MARIE CIMADON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ALBANY AVE
HARTFORD CT
06105-1001
US

IV. Provider business mailing address

1680 ALBANY AVE
HARTFORD CT
06105-1001
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-4511
  • Fax: 860-231-8449
Mailing address:
  • Phone: 860-236-4511
  • Fax: 860-231-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8525
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: