Provider Demographics
NPI:1174662761
Name:PREZKUTA-DIAZ, LORRAINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:PREZKUTA-DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 DUTCHESS TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6442
Mailing Address - Country:US
Mailing Address - Phone:845-264-1200
Mailing Address - Fax:
Practice Address - Street 1:695 DUTCHESS TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6442
Practice Address - Country:US
Practice Address - Phone:845-264-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0707941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical