Individual
MS. DIANE MARIE BLACKWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW LADC
Contact information
Practice address
31 UNION ST, VERNON ROCKVILLE, CT 06066-3126
(860) 872-0501
Mailing address
31 UNION ST, VERNON ROCKVILLE, CT 06066-3126
(860) 380-7228
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1239
CT
104100000X
Social Worker
1040
CT
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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