Provider Demographics
NPI:1437729688
Name:MARSHALL, DIANE (MS, LMHC, CRC)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3106
Mailing Address - Country:US
Mailing Address - Phone:607-329-3425
Mailing Address - Fax:
Practice Address - Street 1:188 CEDAR ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3106
Practice Address - Country:US
Practice Address - Phone:607-329-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty