Healthcare Provider Details

I. General information

NPI: 1770130635
Provider Name (Legal Business Name): DIARA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2019
Last Update Date: 08/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 ROBERT HART DR
DANSVILLE NY
14437-8931
US

IV. Provider business mailing address

111 CLARA BARTON ST
DANSVILLE NY
14437-9503
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-4316
  • Fax: 585-335-3577
Mailing address:
  • Phone: 585-335-6038
  • Fax: 585-335-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: