Provider Demographics
NPI:1245593060
Name:ST.AMOUR, DARLENE DIANE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:DIANE
Last Name:ST.AMOUR
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:DARLENE
Other - Middle Name:DIANE
Other - Last Name:BRANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 WHITE BIRCH LANE
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:INDIAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12842-0250
Mailing Address - Country:US
Mailing Address - Phone:518-648-6497
Mailing Address - Fax:518-648-6143
Practice Address - Street 1:139 WHITE BIRCH LANE
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-0250
Practice Address - Country:US
Practice Address - Phone:518-648-6497
Practice Address - Fax:518-648-6143
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator