Provider Demographics
NPI:1942807276
Name:JASON DIANA LMSW
Entity Type:Organization
Organization Name:JASON DIANA LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DIANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:516-557-7510
Mailing Address - Street 1:1072 JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:516-557-7510
Mailing Address - Fax:
Practice Address - Street 1:50 WEST HAWTHORNE AVE 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-569-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)