Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 081986-1 | NY |
NPI | 1003062415 |
---|---|
Provider Name | Ms. Diana Melisa Idelson |
First Address | Highland Mills, NY 10930-2934 |
Second Address | New Windsor, NY 12553-7258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 22/03/2019 |