Provider Demographics
NPI:1659726859
Name:GOTT, DIANNA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:R
Last Name:GOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:
Other - Last Name:RANDAZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1146
Mailing Address - Country:US
Mailing Address - Phone:631-793-6633
Mailing Address - Fax:
Practice Address - Street 1:7 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1146
Practice Address - Country:US
Practice Address - Phone:631-793-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096931104100000X
NY0886761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker