Provider Demographics
NPI:1699812339
Name:ROMA, DIANE MARIAN (MSW, DSW)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIAN
Last Name:ROMA
Suffix:
Gender:F
Credentials:MSW, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 FIELDSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1803
Mailing Address - Country:US
Mailing Address - Phone:718-601-0728
Mailing Address - Fax:718-458-4481
Practice Address - Street 1:6714 41ST AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3790
Practice Address - Country:US
Practice Address - Phone:718-458-4243
Practice Address - Fax:718-458-4481
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR157921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical