Provider Demographics
NPI:1134498843
Name:MARSIN-FURST, DIANE (LCSW, PLLC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MARSIN-FURST
Suffix:
Gender:F
Credentials:LCSW, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAIN ST STE 2.2
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2144
Mailing Address - Country:US
Mailing Address - Phone:845-294-1635
Mailing Address - Fax:845-258-4611
Practice Address - Street 1:25 MAIN ST STE 2.2
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2144
Practice Address - Country:US
Practice Address - Phone:845-294-1635
Practice Address - Fax:845-258-4611
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR078854-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical