Provider Demographics
NPI:1043336571
Name:DIANE CAROLAN STEGMAN PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:DIANE CAROLAN STEGMAN PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROLAN-STEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:937-298-6288
Mailing Address - Street 1:500 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3492
Mailing Address - Country:US
Mailing Address - Phone:937-298-6288
Mailing Address - Fax:937-298-6271
Practice Address - Street 1:500 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3492
Practice Address - Country:US
Practice Address - Phone:937-298-6288
Practice Address - Fax:937-298-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI39511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty