Provider Demographics
NPI:1013346220
Name:DIATLO, ZELDA
Entity Type:Individual
Prefix:
First Name:ZELDA
Middle Name:
Last Name:DIATLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZELDA
Other - Middle Name:DIATLO
Other - Last Name:EDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW
Mailing Address - Street 1:140 WEST END AVE
Mailing Address - Street 2:14C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:646-283-2273
Mailing Address - Fax:212-725-3986
Practice Address - Street 1:140 W END AVE
Practice Address - Street 2:14C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6131
Practice Address - Country:US
Practice Address - Phone:646-283-2273
Practice Address - Fax:212-725-3986
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP017806-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical