Provider Demographics
NPI:1730546573
Name:BENTHAM-LOWE, DIANA (LCDP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BENTHAM-LOWE
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 GIBBS AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2884
Mailing Address - Country:US
Mailing Address - Phone:401-787-0288
Mailing Address - Fax:
Practice Address - Street 1:73 PELHAM ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3113
Practice Address - Country:US
Practice Address - Phone:401-787-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00460101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)