Provider Demographics
NPI:1225092174
Name:SPIRO, DIANE LIGHT (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LIGHT
Last Name:SPIRO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ACADEMY ST APT 9B
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4597
Mailing Address - Country:US
Mailing Address - Phone:914-474-8659
Mailing Address - Fax:888-972-5017
Practice Address - Street 1:160 ACADEMY ST APT 9B
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4597
Practice Address - Country:US
Practice Address - Phone:914-474-8659
Practice Address - Fax:888-972-5017
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-16
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043943-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02767480Medicaid
NYP51473Medicare UPIN
NY02767480Medicaid