Healthcare Provider Details

I. General information

NPI: 1386003903
Provider Name (Legal Business Name): ADAM JOSEPH DIEMAR BSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GREEN ST SUITE 500
ITHACA NY
14850-5635
US

IV. Provider business mailing address

201 E GREEN ST SUITE 500
ITHACA NY
14850-5635
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6288
  • Fax: 607-274-6280
Mailing address:
  • Phone: 607-274-6288
  • Fax: 607-274-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: