Healthcare Provider Details

I. General information

NPI: 1558630913
Provider Name (Legal Business Name): DIANA T. DURSO LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SCHOOLHOUSE RD
DEERFIELD NY
13502-1135
US

IV. Provider business mailing address

115 SCHOOLHOUSE RD
DEERFIELD NY
13502-1135
US

V. Phone/Fax

Practice location:
  • Phone: 315-266-3415
  • Fax: 315-797-7145
Mailing address:
  • Phone: 315-266-3415
  • Fax: 315-797-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberRO52126
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: