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General NPI Number Information
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NPI Number | 1255672655
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Entity Type | Individual
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Provider Name | DIANE MARTORI LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/09/2013
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 16110 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-6139
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Country | US
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Telephone | 718-704-5488
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Fax | 718-704-5485
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Provider Business Mailing Address
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Address Line | 24211 90TH AVE
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City | BELLEROSE
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State | NY
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Zip | 11426-1115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 079833-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 082309-1
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License Number State | NY
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