MEDICARE: DIANE BERS MALKIN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	078081	NY

General Provider Information

NPI Number	:	1588964597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE BERS MALKIN LCSW

Provider Business Mailing Address
First Line	:	102 HUNTLEY DR
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-1614
Country	:	US
Telephone Number	:	917-881-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 SAW MILL RIVER RD STE 3C-4
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-2157
Country	:	US
Telephone Number	:	914-920-7135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	01/01/2026

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