Provider Demographics
NPI:1356565162
Name:VON DIETSCH, CHRISTINA RENEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RENEE
Last Name:VON DIETSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CORNWALL MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2652
Mailing Address - Country:US
Mailing Address - Phone:845-878-3590
Mailing Address - Fax:
Practice Address - Street 1:215 CORNWALL MEADOWS LN
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2652
Practice Address - Country:US
Practice Address - Phone:845-878-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0955211041C0700X
NY198554146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty