=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053066977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLATIRON PSYCHOTHERAPY LCSW, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 02/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 5TH AVE RM 1707
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-6641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-587-7618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 234 LOOKING GLASS HILL RD
-----------------------------------------------------
City | MORRIS
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06763-1024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-301-4045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. DIANE MARIE BARNES
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 917-301-4045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------