Provider Demographics
NPI:1689908733
Name:RODE, DIANE (MPS, CCLS, LCAT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:RODE
Suffix:
Gender:F
Credentials:MPS, CCLS, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1153
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-8024
Mailing Address - Fax:212-427-3049
Practice Address - Street 1:1184 5TH AVE
Practice Address - Street 2:ROOM 350
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6503
Practice Address - Country:US
Practice Address - Phone:212-241-8024
Practice Address - Fax:212-427-3049
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000048-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist