Provider Demographics
NPI:1518360585
Name:MOROZOV, DIANA (PSYD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MOROZOV
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PLAZA ST E STE 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4939
Mailing Address - Country:US
Mailing Address - Phone:347-770-7631
Mailing Address - Fax:
Practice Address - Street 1:10 PLAZA ST E STE 1C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4939
Practice Address - Country:US
Practice Address - Phone:347-770-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020920-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist