MEDICARE: DR. DIANE TIRADO-LAMPERT PH.D.

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	R025510-1	NY

General Provider Information

NPI Number	:	1851455984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE TIRADO-LAMPERT PH.D.

Provider Business Mailing Address
First Line	:	1346 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3906
Country	:	US
Telephone Number	:	718-447-6556
Fax Number	:	718-447-6556

Provider Business Practice Location Address
First Line	:	1346 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3906
Country	:	US
Telephone Number	:	718-447-6556
Fax Number	:	718-447-6556

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	02/14/2012

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