Healthcare Provider Details

I. General information

NPI: 1962937573
Provider Name (Legal Business Name): DIANE RAPACIOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9027 SUTPHIN BLVD 5TH FLOOR
JAMAICA NY
11435-3647
US

IV. Provider business mailing address

9027 SUTPHIN BLVD 5TH FLOOR
JAMAICA NY
11435-3647
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax:
Mailing address:
  • Phone: 718-526-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070395-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: