Provider Demographics
NPI:1295285591
Name:GOFT, DIANA (MS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GOFT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 OCEAN PKWY
Mailing Address - Street 2:6C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8200
Mailing Address - Country:US
Mailing Address - Phone:718-864-9269
Mailing Address - Fax:
Practice Address - Street 1:2940 OCEAN PKWY
Practice Address - Street 2:6C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8200
Practice Address - Country:US
Practice Address - Phone:718-864-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2603411106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst