Provider Demographics
NPI:1376634634
Name:SANDLER-DERBY, DIANE MARSHA (MSW, CASAC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARSHA
Last Name:SANDLER-DERBY
Suffix:
Gender:F
Credentials:MSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 DAFFODIL LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1802
Mailing Address - Country:US
Mailing Address - Phone:516-783-8374
Mailing Address - Fax:516-783-0220
Practice Address - Street 1:42 DAFFODIL LN
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1802
Practice Address - Country:US
Practice Address - Phone:516-783-8374
Practice Address - Fax:516-783-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4882101YA0400X
NYR0336481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN54091OtherBLUE CHOICE
NY7402751OtherBLUE CHOICE
NYAS230OtherOXFORD
NY7402751OtherBLUE CHOICE