Healthcare Provider Details

I. General information

NPI: 1023219417
Provider Name (Legal Business Name): ORSOLYA DIANA CLIFFORD LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAIN ST
NYACK NY
10960-3109
US

IV. Provider business mailing address

17 ROUTE 340
ORANGEBURG NY
10962-2202
US

V. Phone/Fax

Practice location:
  • Phone: 845-664-3820
  • Fax:
Mailing address:
  • Phone: 845-664-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05287500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076110-1
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: