Provider Demographics
NPI:1922537596
Name:BERNSTEIN, DIANA (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:PEDEVILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 RAMBLING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1128
Mailing Address - Country:US
Mailing Address - Phone:201-978-9244
Mailing Address - Fax:
Practice Address - Street 1:115 PINE ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1619
Practice Address - Country:US
Practice Address - Phone:201-978-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL058832001041C0700X
NJ44SLO58832001041C0700X
44SL058832001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical