Provider Demographics
NPI:1134137565
Name:CHILLO-HAVERCAMP, DIANNA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:
Last Name:CHILLO-HAVERCAMP
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 1:367 WINDSOR HWY # 449
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7900
Mailing Address - Country:US
Mailing Address - Phone:845-293-2328
Mailing Address - Fax:
Practice Address - Street 1:815 BLOOMING GROVE TPKE STE 501
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8134
Practice Address - Country:US
Practice Address - Phone:845-293-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071726-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical