Basic Information
| Provider Information | |||||||||
| NPI: | 1992096499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDMAN | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 ATLANTIC AVE APT A1C | ||||||||
| Address2: | |||||||||
| City: | LYNBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115633524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6468532755 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2369 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100353108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128762300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2011 | ||||||||
| LastUpdateDate: | 05/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 069425 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.