Provider Demographics
NPI:1962685883
Name:OHANLON, DIANE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:OHANLON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MACLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:597 BAY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1444
Mailing Address - Country:US
Mailing Address - Phone:515-793-1160
Mailing Address - Fax:518-793-1255
Practice Address - Street 1:597 BAY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1444
Practice Address - Country:US
Practice Address - Phone:515-793-1160
Practice Address - Fax:518-793-1255
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-070822-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical