Provider Demographics
NPI:1013019587
Name:LANGONA, DIANNE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:
Last Name:LANGONA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-1310
Mailing Address - Country:US
Mailing Address - Phone:802-291-3195
Mailing Address - Fax:
Practice Address - Street 1:20 HIGH ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1310
Practice Address - Country:US
Practice Address - Phone:802-291-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0333231041C0700X
VT089-00011821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN637F1Medicare ID - Type UnspecifiedMEDICARE PART B