Provider Demographics
NPI:1043221948
Name:PRIOR, DIANE M (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:PRIOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 REGENT TER
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4951
Mailing Address - Country:US
Mailing Address - Phone:203-783-9648
Mailing Address - Fax:
Practice Address - Street 1:25 REGENT TER
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4951
Practice Address - Country:US
Practice Address - Phone:203-783-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0055911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC.A.Q.H.Other11244119