Provider Demographics
NPI:1275978843
Name:WASHINGTON, DIANA (MSED & MS)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MSED & MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BEAUMONT CIR
Mailing Address - Street 2:APT 4
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1513
Mailing Address - Country:US
Mailing Address - Phone:718-790-0725
Mailing Address - Fax:718-299-8745
Practice Address - Street 1:3140B E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5706
Practice Address - Country:US
Practice Address - Phone:718-239-4147
Practice Address - Fax:718-239-4310
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692312121174400000X
NY316468091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist