Provider Demographics
NPI:1831715440
Name:BARNES, DIANDRA SUSIE (LCSW)
Entity type:Individual
Prefix:
First Name:DIANDRA
Middle Name:SUSIE
Last Name:BARNES
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 1:63 E CENTER ST STE 2R
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5221
Mailing Address - Country:US
Mailing Address - Phone:860-281-1133
Mailing Address - Fax:860-650-0655
Practice Address - Street 1:63 E CENTER ST STE 2R
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5221
Practice Address - Country:US
Practice Address - Phone:860-281-1133
Practice Address - Fax:860-650-0655
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT108711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical