Provider Demographics
NPI:1457117715
Name:CASSELL-SMITH, DIANE JOY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JOY
Last Name:CASSELL-SMITH
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 1:35 EMERSON TER
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1359
Mailing Address - Country:US
Mailing Address - Phone:914-489-9214
Mailing Address - Fax:
Practice Address - Street 1:720 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4346
Practice Address - Country:US
Practice Address - Phone:845-341-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NYR0298161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty