Individual
DIANE BRACAMONTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2016 VADALABENE DR STE A, MARYVILLE, IL 62062-6901
(618) 823-6444
(618) 551-8456
Mailing address
2016 VADALABENE DR STE A, MARYVILLE, IL 62062-6901
(618) 823-6444
(618) 551-8456
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149013539
IL
Other
Enumeration date
04/13/2009
Last updated
03/08/2016
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