MEDICARE: MRS. DIANA DEASEN PACHE 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
1	104100000X	Social Worker		NY

General Provider Information

NPI Number	:	1982231858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA DEASEN PACHE LMSW

Provider Business Mailing Address
First Line	:	818 ELTON AVE APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-4520
Country	:	US
Telephone Number	:	646-659-4393
Fax Number	:

Provider Business Practice Location Address
First Line	:	818 ELTON AVE APT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-4520
Country	:	US
Telephone Number	:	646-659-4393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	03/23/2020

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