Provider Demographics
NPI:1013467422
Name:COUVERTIER, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:COUVERTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1916
Mailing Address - Country:US
Mailing Address - Phone:718-924-9316
Mailing Address - Fax:
Practice Address - Street 1:1017 REVERE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1916
Practice Address - Country:US
Practice Address - Phone:718-924-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst