Provider Demographics
NPI:1114207636
Name:BURNS-WETZEL, DIANA (LCSW, CASAC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BURNS-WETZEL
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 COMMERCE ST
Mailing Address - Street 2:221
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4412
Mailing Address - Country:US
Mailing Address - Phone:914-736-9433
Mailing Address - Fax:
Practice Address - Street 1:3565 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-7232
Practice Address - Country:US
Practice Address - Phone:914-736-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0741521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical