Provider Demographics
NPI:1740367077
Name:DIBONA, AMY I (LMSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:I
Last Name:DIBONA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BANK ST # 70
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2109
Mailing Address - Country:US
Mailing Address - Phone:212-675-9409
Mailing Address - Fax:
Practice Address - Street 1:99 BANK ST # 70
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2109
Practice Address - Country:US
Practice Address - Phone:212-675-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY071460OtherNYS LICENSE