Provider Demographics
NPI:1033771225
Name:WITMER, DIANE KRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KRISTINA
Last Name:WITMER
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 1:56 MARILYNN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2703
Mailing Address - Country:US
Mailing Address - Phone:631-338-3913
Mailing Address - Fax:
Practice Address - Street 1:56 MARILYNN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2703
Practice Address - Country:US
Practice Address - Phone:631-338-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0881741041C0700X
VA09040111271041C0700X
TN70581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical