Provider Demographics
NPI:1710185749
Name:DIANA, STEPHEN GUY (LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GUY
Last Name:DIANA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 UPPER BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:QUAKER HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06375-1131
Mailing Address - Country:US
Mailing Address - Phone:860-440-3193
Mailing Address - Fax:
Practice Address - Street 1:CATHOLIC CHARITIES, DIOCESE OF NORWICH
Practice Address - Street 2:331 MAIN STREET
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-889-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist