Provider Demographics
NPI:1992842488
Name:DEGIOVINE, DIANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:DEGIOVINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:5060-2 STATE RT. 30
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-0664
Mailing Address - Country:US
Mailing Address - Phone:518-295-8090
Mailing Address - Fax:
Practice Address - Street 1:5060-2 STATE RT. 30
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-0664
Practice Address - Country:US
Practice Address - Phone:518-295-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034060-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health