Provider Demographics
NPI:1093324618
Name:POPOVICH, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 RHONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1063
Mailing Address - Country:US
Mailing Address - Phone:347-229-4764
Mailing Address - Fax:
Practice Address - Street 1:30 BROAD ST FL 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2906
Practice Address - Country:US
Practice Address - Phone:212-512-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst