Provider Demographics
NPI:1043757891
Name:DURIVAGE, DIANE E (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:DURIVAGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NEW KARNER RD
Mailing Address - Street 2:STE 1A
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3874
Mailing Address - Country:US
Mailing Address - Phone:518-452-1337
Mailing Address - Fax:518-724-6660
Practice Address - Street 1:501 NEW KARNER RD
Practice Address - Street 2:STE 1A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3874
Practice Address - Country:US
Practice Address - Phone:518-452-1337
Practice Address - Fax:518-724-6660
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095881104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker