Provider Demographics
NPI:1245589720
Name:SARDELLA, DIANE LINDSAY (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LINDSAY
Last Name:SARDELLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2-8 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2308
Mailing Address - Country:US
Mailing Address - Phone:518-762-8215
Mailing Address - Fax:
Practice Address - Street 1:2-8 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2308
Practice Address - Country:US
Practice Address - Phone:518-762-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080997-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker