Provider Demographics
NPI:1003062415
Name:IDELSON, DIANA MELISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MELISA
Last Name:IDELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2934
Mailing Address - Country:US
Mailing Address - Phone:845-537-5706
Mailing Address - Fax:
Practice Address - Street 1:1124 ROUTE 94 STE 201
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7258
Practice Address - Country:US
Practice Address - Phone:845-787-1355
Practice Address - Fax:845-787-1366
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081986-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical