Provider Demographics
NPI:1265731780
Name:HAN, DIANA (LMSW)
Entity type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 1ST AVE
Mailing Address - Street 2:ROOM 18S11
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-562-4617
Mailing Address - Fax:212-562-3534
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:ROOM 18S11
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-4617
Practice Address - Fax:212-562-3534
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077850104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker