=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093040370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA RACHEL ZELVIN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2009
-----------------------------------------------------
Last Update Date | 10/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 928 BROADWAY SUITE 1200
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-733-4571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 MILTON ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11222-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-733-4571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 052240-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------