Healthcare Provider Details

I. General information

NPI: 1306571005
Provider Name (Legal Business Name): DI AI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 CANAL ST
NEW YORK NY
10013-3599
US

IV. Provider business mailing address

125 WALKER ST FL 2
NEW YORK NY
10013-4135
US

V. Phone/Fax

Practice location:
  • Phone: 212-941-2213
  • Fax: 212-941-2180
Mailing address:
  • Phone: 212-226-8866
  • Fax: 212-226-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099308
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier08114078
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: