Provider Demographics
NPI:1639812324
Name:GAY, DIANDRA
Entity Type:Individual
Prefix:
First Name:DIANDRA
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WYCKOFF AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-5842
Mailing Address - Country:US
Mailing Address - Phone:718-497-6090
Mailing Address - Fax:
Practice Address - Street 1:315 WYCKOFF AVE STE 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5842
Practice Address - Country:US
Practice Address - Phone:718-497-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty