Provider Demographics
NPI:1902017031
Name:JOHNSON, DIANA WEST (MS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:WEST
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HEMPSTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2116
Mailing Address - Country:US
Mailing Address - Phone:516-567-3986
Mailing Address - Fax:516-486-5403
Practice Address - Street 1:496 UNIONDALE AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-2201
Practice Address - Country:US
Practice Address - Phone:646-285-4109
Practice Address - Fax:516-538-1974
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000582-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health