Provider Demographics
NPI:1023464146
Name:DIASPARRA, DIANE (MS ED)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:DIASPARRA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:PINE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12567-5516
Mailing Address - Country:US
Mailing Address - Phone:631-335-3502
Mailing Address - Fax:
Practice Address - Street 1:67 BIRCH DRIVE
Practice Address - Street 2:
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567-9998
Practice Address - Country:US
Practice Address - Phone:631-335-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY835387252Y00000X
NY002157103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No252Y00000XAgenciesEarly Intervention Provider Agency