Provider Demographics
NPI:1346432127
Name:DIAKIWSKI, ANDREW DORIAN (MA, MED)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DORIAN
Last Name:DIAKIWSKI
Suffix:
Gender:M
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 36TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1344
Mailing Address - Country:US
Mailing Address - Phone:917-572-6417
Mailing Address - Fax:
Practice Address - Street 1:3029 38TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3875
Practice Address - Country:US
Practice Address - Phone:917-572-6417
Practice Address - Fax:646-568-5324
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000579-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health