Provider Demographics
NPI:1457636425
Name:DECOSTE, DIANNE (LICSW PLLC)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:DECOSTE
Suffix:
Gender:F
Credentials:LICSW PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 DOVER RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:CHICHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03258-6537
Mailing Address - Country:US
Mailing Address - Phone:603-486-2275
Mailing Address - Fax:
Practice Address - Street 1:160 DOVER RD
Practice Address - Street 2:SUITE #5
Practice Address - City:CHICHESTER
Practice Address - State:NH
Practice Address - Zip Code:03258-6537
Practice Address - Country:US
Practice Address - Phone:603-486-2275
Practice Address - Fax:603-798-3104
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical