Provider Demographics
NPI:1821118548
Name:SVENNING, DIANE MARY (LCSW, LCAC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARY
Last Name:SVENNING
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2432
Mailing Address - Country:US
Mailing Address - Phone:860-443-5328
Mailing Address - Fax:860-443-6031
Practice Address - Street 1:331 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5836
Practice Address - Country:US
Practice Address - Phone:860-889-8346
Practice Address - Fax:860-889-2658
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical