Provider Demographics
NPI:1780913350
Name:DUGAN, DIANNE C (LICSW)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:C
Last Name:DUGAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HEALTH LN
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2711
Mailing Address - Country:US
Mailing Address - Phone:774-275-7861
Mailing Address - Fax:
Practice Address - Street 1:50 HEALTH LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2711
Practice Address - Country:US
Practice Address - Phone:401-732-5656
Practice Address - Fax:401-738-8634
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146341041C0700X
RIISW001461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical