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General NPI Number Information
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NPI Number | 1730574088
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Entity Type | Organization
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Legal Business Name | DIANE A GARIEPY LCSW PC
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 460 OLD TOWN ROAD 21-G
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776
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Country | US
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Telephone | 631-642-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 646 MAIN ST 2ND FLOOR
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2235
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Country | US
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Telephone | 631-642-7474
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE ALICE GARIEPY
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Credential | LCSWR,ND
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Telephone | 631-642-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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