Provider Demographics
NPI:1174965719
Name:LAFFERTY, DIANE C (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:C
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SIEMON COMPANY DR 111S
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2654
Mailing Address - Country:US
Mailing Address - Phone:203-592-4483
Mailing Address - Fax:860-417-6789
Practice Address - Street 1:27 SIEMON COMPANY DR 111S
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2654
Practice Address - Country:US
Practice Address - Phone:203-592-4483
Practice Address - Fax:860-417-6789
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical