Provider Demographics
NPI:1437587474
Name:FREMONT, DIANE M (LSCW-R)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:FREMONT
Suffix:
Gender:F
Credentials:LSCW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PATCHIN PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8341
Mailing Address - Country:US
Mailing Address - Phone:212-714-5018
Mailing Address - Fax:
Practice Address - Street 1:7 PATCHIN PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8341
Practice Address - Country:US
Practice Address - Phone:212-714-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL056975-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical