Provider Demographics
NPI:1922185081
Name:CARTER, DIANE B (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3030
Mailing Address - Country:US
Mailing Address - Phone:860-298-0680
Mailing Address - Fax:860-298-0470
Practice Address - Street 1:340 BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3030
Practice Address - Country:US
Practice Address - Phone:860-298-0680
Practice Address - Fax:860-298-0470
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0018391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical