Provider Demographics
NPI:1902397490
Name:SOSA, DIANE ALEXY (LPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ALEXY
Last Name:SOSA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CHAMBERLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1418
Mailing Address - Country:US
Mailing Address - Phone:201-523-2129
Mailing Address - Fax:
Practice Address - Street 1:115 RIVER RD STE 118
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1009
Practice Address - Country:US
Practice Address - Phone:201-523-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00631300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional