Provider Demographics
NPI:1578623468
Name:CHAISSON, DIANE MARY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARY
Last Name:CHAISSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5371
Mailing Address - Country:US
Mailing Address - Phone:978-343-4100
Mailing Address - Fax:978-343-4559
Practice Address - Street 1:551 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5371
Practice Address - Country:US
Practice Address - Phone:978-343-4100
Practice Address - Fax:978-343-4559
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1145411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical