Provider Demographics
NPI:1154508661
Name:FRANCO, DIANA (LCSW-R, DSW)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:FRANCO
Suffix:
Gender:F
Credentials:LCSW-R, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUNSET CANYON LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1454
Mailing Address - Country:US
Mailing Address - Phone:505-231-6620
Mailing Address - Fax:
Practice Address - Street 1:9231 57TH AVE
Practice Address - Street 2:APT 4A - BELL #5
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:917-359-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0694201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY385716POtherHIP
NY7046886OtherAETNA