Provider Demographics
NPI:1477615854
Name:DIENGOTT, CARYL ELLEN (MSW, LICSW, C-ASWCM)
Entity type:Individual
Prefix:MS
First Name:CARYL
Middle Name:ELLEN
Last Name:DIENGOTT
Suffix:
Gender:F
Credentials:MSW, LICSW, C-ASWCM
Other - Prefix:MS
Other - First Name:CARYL
Other - Middle Name:ELLEN
Other - Last Name:DIENGOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW, C-ASWCM
Mailing Address - Street 1:34 HATTIE LANE
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3520
Mailing Address - Country:US
Mailing Address - Phone:978-436-9998
Mailing Address - Fax:
Practice Address - Street 1:34 HATTIE LANE
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3520
Practice Address - Country:US
Practice Address - Phone:978-436-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027877101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor