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MS. DIANE MARIE BLACKWOOD LMSW LADC

>> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1811407133

Individual Registrant:
MS. DIANE MARIE BLACKWOOD LMSW LADC
Gender: F
Sole Proprietor

Location and contact information for practice:
31 UNION ST  VERNON ROCKVILLE, CT 06066-3126 US
Tel: 860-872-0501  Fax: --

Contact information for business:
31 UNION ST  VERNON ROCKVILLE, CT 06066-3126 US
Tel: 860-380-7228  Fax: --

Registration Information:
NPI: 1811407133
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N104100000XBehavioral Health & Social Service Providers
Social Worker
CT1040
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
CT1239

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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