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General NPI Number Information
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NPI Number | 1508692310
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Entity Type | Organization
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Legal Business Name | DIANE GIANCASPRO LCSW LLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 28 S FRANKLIN ST
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City | NEW BUFFALO
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State | MI
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Zip | 49117-1554
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Country | US
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Telephone | 269-405-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 28 S FRANKLIN ST
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City | NEW BUFFALO
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State | MI
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Zip | 49117-1554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DIANE LORRAINE GIANCASPRO
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Credential | LCSW
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Telephone | 269-405-3644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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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 |
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License Number State |
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