Healthcare Provider Details

I. General information

NPI: 1467909770
Provider Name (Legal Business Name): DIANE SOLANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CHURCH ST
WALLINGFORD CT
06492-2253
US

IV. Provider business mailing address

104 KENYON CIR
NEW BRITAIN CT
06053-2215
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-7770
  • Fax:
Mailing address:
  • Phone: 860-604-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009570
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: