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General NPI Number Information
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NPI Number | 1831609171
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Entity Type | Individual
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Provider Name | DIANA SADJADI-FARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/30/2017
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 416 HIGHLAND AVENUE BUILD B SUITE 6
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City | CHESHIRE
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State | CT
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Zip | 06410-2527
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Country | US
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Telephone | 347-227-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 166 HUDSON ST FL 1
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City | BERLIN
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State | CT
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Zip | 06037-3113
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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 |
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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 | 9938
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License Number State | CT
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