Provider Demographics
NPI:1679348049
Name:MARTOCCHIA, DIANA C (CARC COACH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:MARTOCCHIA
Suffix:
Gender:F
Credentials:CARC COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SCULPIN WAY
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2664
Mailing Address - Country:US
Mailing Address - Phone:617-458-2563
Mailing Address - Fax:
Practice Address - Street 1:31 SCULPIN WAY
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2664
Practice Address - Country:US
Practice Address - Phone:617-458-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)