Provider Demographics
NPI:1225276975
Name:DISLA-THORNE, ZENEIDA (MA)
Entity Type:Individual
Prefix:
First Name:ZENEIDA
Middle Name:
Last Name:DISLA-THORNE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MALCOLM X BLVD
Mailing Address - Street 2:17B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:470 MALCOLM X BLVD
Practice Address - Street 2:17B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3003
Practice Address - Country:US
Practice Address - Phone:212-491-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0000315-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor