Provider Demographics
NPI:1790811594
Name:CALHOUN, DIANA FREIDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:FREIDA
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 PALMER DR
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1014
Mailing Address - Country:US
Mailing Address - Phone:845-358-0851
Mailing Address - Fax:845-348-0917
Practice Address - Street 1:604 PALMER DR
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1014
Practice Address - Country:US
Practice Address - Phone:845-358-0851
Practice Address - Fax:845-348-0917
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0241581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY118592OtherCHAMPUS
NJSC00779OtherNJ LICENSE NUMBER
NY01466462Medicaid
NY024158OtherNY LICENSE NUMBER
NY118592OtherCHAMPUS
NY024158OtherNY LICENSE NUMBER