Provider Demographics
NPI:1942998968
Name:PISCOTTANO, STACEY DIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DIANA
Last Name:PISCOTTANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 GOODRICH ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2612
Mailing Address - Country:US
Mailing Address - Phone:860-597-3605
Mailing Address - Fax:
Practice Address - Street 1:602 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-4033
Practice Address - Country:US
Practice Address - Phone:860-249-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker