MEDICARE: MRS. DIANE V ST.ONGE MSW, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0392	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101YAO400X	OTHER	NH	ADDICTION COUNSELOR

General Provider Information

NPI Number	:	1942322235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE V ST.ONGE MSW, LADC

Provider Business Mailing Address
First Line	:	18 BROOKFIELD DR
Second Line	:
City	:	HUDSON
State	:	NH
Zip	:	03051-5001
Country	:	US
Telephone Number	:	603-622-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 BROOKFIELD DR
Second Line	:
City	:	HUDSON
State	:	NH
Zip	:	03051-5001
Country	:	US
Telephone Number	:	603-622-4747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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