Provider Demographics
NPI:1265681480
Name:DIETZ, VERNON HENRY JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:HENRY
Last Name:DIETZ
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 34TH ST
Mailing Address - Street 2:5A
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103-5246
Mailing Address - Country:US
Mailing Address - Phone:718-274-5321
Mailing Address - Fax:
Practice Address - Street 1:146-01 45TH AVENUE, #310
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0788621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical