Provider Demographics
NPI:1043528391
Name:DIANE E, CASALAINA, MA, LADC, LLC
Entity type:Organization
Organization Name:DIANE E, CASALAINA, MA, LADC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:CASALAINA
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-301-4660
Mailing Address - Street 1:31 CHERRY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3465
Mailing Address - Country:US
Mailing Address - Phone:203-301-4659
Mailing Address - Fax:
Practice Address - Street 1:31 CHERRY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3465
Practice Address - Country:US
Practice Address - Phone:203-301-4659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000805101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
300000805CT01OtherBLUE CROSS BLUE SHIELD ANTHEM
CT008001912Medicaid