Provider Demographics
NPI:1669637989
Name:MITAL, DIANE KAREN
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAREN
Last Name:MITAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:KAREN
Other - Last Name:SCHOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 CONNOLLY PARKWAY
Mailing Address - Street 2:BLDG, 17A
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:203-230-2815
Mailing Address - Fax:203-230-8502
Practice Address - Street 1:60 CONNOLLY PARKWAY
Practice Address - Street 2:BLDG, 17A
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:406-375-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1131235Z00000X
CT004600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist