Provider Demographics
NPI:1760989297
Name:VANKEVICH, DIANE MARIE (MA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:VANKEVICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BUCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-3926
Mailing Address - Country:US
Mailing Address - Phone:413-262-1264
Mailing Address - Fax:
Practice Address - Street 1:1160 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-3122
Practice Address - Country:US
Practice Address - Phone:413-455-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor