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General NPI Number Information
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NPI Number | 1023192309
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Entity Type | Individual
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Provider Name | DIANE K VIVEIROS MSW (LCSW/LICSW)
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 184 LIBERTY ST LV110
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City | NEW HAVEN
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State | CT
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Zip | 06519-1625
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Country | US
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Telephone | 203-688-9926
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Fax |
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Provider Business Mailing Address
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Address Line | 77 HILLCREST RD
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City | GLASTONBURY
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State | CT
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Zip | 06033-3101
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Country | US
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Telephone | 203-688-9754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1019597
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 004489
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License Number State | CT
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