Provider Demographics
NPI:1558695825
Name:DIMITRI, DIANA MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIA
Last Name:DIMITRI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2207
Mailing Address - Country:US
Mailing Address - Phone:347-642-3201
Mailing Address - Fax:
Practice Address - Street 1:909 3RD AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4731
Practice Address - Country:US
Practice Address - Phone:646-495-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical