Provider Demographics
NPI:1295702975
Name:CARNOALI, DIANE (LMSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CARNOALI
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 1:1906 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4259
Mailing Address - Country:US
Mailing Address - Phone:970-945-6535
Mailing Address - Fax:970-384-6782
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-945-6535
Practice Address - Fax:970-384-6782
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6060104100000X
CO099237791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09923779OtherDORA COLORADO
KS100117700AMedicaid