Provider Demographics
NPI:1376196048
Name:DIEMER, DYAN LESLEY (LMT, BCPP)
Entity Type:Individual
Prefix:MS
First Name:DYAN
Middle Name:LESLEY
Last Name:DIEMER
Suffix:
Gender:F
Credentials:LMT, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE POSITIVE MIND CENTER
Mailing Address - Street 2:119 WEST 57TH STREET SUITE 1100
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:917-626-3799
Mailing Address - Fax:
Practice Address - Street 1:THE POSITIVE MIND CENTER
Practice Address - Street 2:119 WEST 57TH STREET SUITE 1100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:917-626-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018259-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist