Provider Demographics
NPI:1104536812
Name:DIVERSITY IN PRACTICE, LCSW, PLLC
Entity type:Organization
Organization Name:DIVERSITY IN PRACTICE, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:JULIUS
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-389-5094
Mailing Address - Street 1:127 W 30TH ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3406
Mailing Address - Country:US
Mailing Address - Phone:646-389-5094
Mailing Address - Fax:
Practice Address - Street 1:127 W 30TH ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3406
Practice Address - Country:US
Practice Address - Phone:646-389-5094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty