Provider Demographics
NPI:1619046208
Name:ROBACZYNSKI, DIANE (APRN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ROBACZYNSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NYE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1281
Mailing Address - Country:US
Mailing Address - Phone:860-657-3056
Mailing Address - Fax:860-633-3517
Practice Address - Street 1:55 NYE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1281
Practice Address - Country:US
Practice Address - Phone:860-657-3056
Practice Address - Fax:860-633-3517
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS49088Medicare UPIN