Provider Demographics
NPI:1891188967
Name:MIRABITO, DIANE MARGARET (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARGARET
Last Name:MIRABITO
Suffix:
Gender:F
Credentials:DSW, LCSW
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Mailing Address - Street 1:4 WASHINGTON SQUARE VLG APT 11J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1907
Mailing Address - Country:US
Mailing Address - Phone:917-623-1309
Mailing Address - Fax:212-995-4588
Practice Address - Street 1:85 5TH AVE STE 903
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:917-623-1309
Practice Address - Fax:212-995-4588
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR037079-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical