Provider Demographics
NPI:1225154362
Name:CONNERTY, DIANA COHEN (MED)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:COHEN
Last Name:CONNERTY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3200
Mailing Address - Country:US
Mailing Address - Phone:508-272-1707
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-977-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health