Provider Demographics
NPI:1255455341
Name:HOLZWORTH, DIANE ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ELIZABETH
Last Name:HOLZWORTH
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 1:102 HOLLOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06365-8709
Mailing Address - Country:US
Mailing Address - Phone:860-608-1584
Mailing Address - Fax:860-859-0712
Practice Address - Street 1:410 SALEM TPKE
Practice Address - Street 2:
Practice Address - City:BOZRAH
Practice Address - State:CT
Practice Address - Zip Code:06334-1519
Practice Address - Country:US
Practice Address - Phone:860-608-1584
Practice Address - Fax:860-859-7012
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical