Provider Demographics
NPI:1083632111
Name:FREEDMAN, DIANE E (RLCSW)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:RLCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:E
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LCSW-R
Mailing Address - Street 1:3016 HICKORY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8507
Mailing Address - Country:US
Mailing Address - Phone:631-786-4202
Mailing Address - Fax:631-737-0001
Practice Address - Street 1:496 SMITHTOWN BYP STE 311
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5005
Practice Address - Country:US
Practice Address - Phone:631-737-5559
Practice Address - Fax:631-737-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0491161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOG661Medicare UPIN
NYA100001770Medicare UPIN