Provider Demographics
NPI:1609916345
Name:SCHULZ HEIDECKER, DIANE MAKIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MAKIE
Last Name:SCHULZ HEIDECKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MAKIE
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:31 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820
Mailing Address - Country:US
Mailing Address - Phone:607-431-1877
Mailing Address - Fax:607-431-1878
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-431-1877
Practice Address - Fax:607-431-1878
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04087311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical