Provider Demographics
NPI:1477955771
Name:POPE, DIANE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:DEDE
Other - Middle Name:
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:140 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1737
Mailing Address - Country:US
Mailing Address - Phone:860-521-6105
Mailing Address - Fax:860-231-6795
Practice Address - Street 1:1019 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3955
Practice Address - Country:US
Practice Address - Phone:860-306-8192
Practice Address - Fax:860-231-6795
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical