Provider Demographics
NPI:1457596611
Name:CASTRUCCI, DIANNE PEPIN (MLADC)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:PEPIN
Last Name:CASTRUCCI
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:PEPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 PEMBROKE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-225-7060
Mailing Address - Fax:603-524-7275
Practice Address - Street 1:130 PEMBROKE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-225-7060
Practice Address - Fax:603-524-7275
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH420101YA0400X
NH0420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)