Provider Demographics
NPI:1669744256
Name:PADERNACHT, DIANE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:PADERNACHT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:PADERNACHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14 GINNY CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3028
Mailing Address - Country:US
Mailing Address - Phone:516-512-1717
Mailing Address - Fax:
Practice Address - Street 1:506 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4706
Practice Address - Country:US
Practice Address - Phone:516-739-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082595104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker