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NPI Code Detail

MEDICARE: MRS. DIANNA LIND-TAVERNA LMSW

MEDICARE: MRS. DIANNA LIND-TAVERNA LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker096787-1NY

General Provider Information

NPI Number : 1699251140
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANNA LIND-TAVERNA LMSW
Provider Business Mailing Address
First Line : 1216 BAY ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3169
Country : US
Telephone Number : 718-718-4774
Fax Number : 718-420-0613
Provider Business Practice Location Address
First Line : 1216 BAY ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3169
Country : US
Telephone Number : 718-718-4774
Fax Number : 718-420-0613
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2018
Last Update Date : 07/18/2018

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