Provider Demographics
NPI:1669418158
Name:OLLECH, DIANNE (CP)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:
Last Name:OLLECH
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W 86TH ST
Mailing Address - Street 2:#17A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3612
Mailing Address - Country:US
Mailing Address - Phone:212-712-2257
Mailing Address - Fax:212-712-2257
Practice Address - Street 1:41 W 86TH ST
Practice Address - Street 2:APT 17A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3612
Practice Address - Country:US
Practice Address - Phone:212-712-2257
Practice Address - Fax:212-712-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012891-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01714887Medicaid
NYV05591Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER