Provider Demographics
NPI:1912397647
Name:CIANFROCCO, DIANNA (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:
Last Name:CIANFROCCO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2110
Mailing Address - Country:US
Mailing Address - Phone:315-271-6122
Mailing Address - Fax:
Practice Address - Street 1:8469 SENECA TPKE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-4900
Practice Address - Country:US
Practice Address - Phone:315-271-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0431651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical