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General NPI Number Information
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NPI Number | 1215252614
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Entity Type | Organization
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Legal Business Name | DIANA DIGIACOMO-CANELLAS,LLC
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 705 N MOUNTAIN RD SUITE 110
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City | NEWINGTON
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State | CT
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Zip | 06111-1412
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Country | US
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Telephone | 860-324-6841
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Fax |
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Provider Business Mailing Address
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Address Line | 6 FREEMAN ST
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City | HARTFORD
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State | CT
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Zip | 06114-2719
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Country | US
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Telephone | 860-324-6841
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. DIANA SILVIA DIGIACOMO-CANELLAS
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Credential | LCSW
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Telephone | 860-324-6841
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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 | 006422
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License Number State | CT
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