Provider Demographics
NPI:1023192309
Name:VIVEIROS, DIANE K (MSW (LCSW/LICSW))
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:VIVEIROS
Suffix:
Gender:F
Credentials:MSW (LCSW/LICSW)
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:K
Other - Last Name:GORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW (LCSW/LLICSW)
Mailing Address - Street 1:77 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3101
Mailing Address - Country:US
Mailing Address - Phone:203-688-9754
Mailing Address - Fax:
Practice Address - Street 1:184 LIBERTY ST
Practice Address - Street 2:LV110
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1625
Practice Address - Country:US
Practice Address - Phone:203-688-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10195971041C0700X
CT0044891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical