Individual provider Active NPI

Diane Fontneau, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Portsmouth, NH
National Provider Identifier
1366990426
Registry record updated Mar 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
1180 Issued in NH
Practice address
1145 Sagamore Ave
Portsmouth, NH 03801-5503
Phone
(603) 431-6703
Fax
(603) 430-3753
NPI assigned
Sep 19, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1002 NH
Mental Health Counselor 101YM0800X NH
Addiction (Substance Use Disorder) Counselor 101YA0400X 1180 NH Primary

Addresses

Primary practice location

1145 Sagamore Ave
Portsmouth, NH 03801-5503

Mailing address

1145 Sagamore Ave
Portsmouth, NH 03801-5503
Phone (603) 431-6703

Other identifiers 1

IdentifierTypeStateIssuer
3078870MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231227000898 NH Practitioner - Mental Health Counselor 4385094721 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2610NHMDPhysical Therapist
1180NHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Seacoast Mental Health Center, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

1145 Sagamore Ave
Portsmouth, NH 03801
Phone (603) 431-6703

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1366990426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 SAGAMORE AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038015503",
            "telephone_number": "603-431-6703",
            "fax_number": "603-430-3753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 SAGAMORE AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038015503",
            "telephone_number": "603-431-6703",
            "fax_number": "603-430-3753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTNEAU",
        "first_name": "DIANE",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-19",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NH",
            "license": "1002",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NH",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NH",
            "license": "1180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3078870",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, NH

Sources for this page

Verify at the official NPI Registry.