Provider Demographics
NPI:1740550821
Name:CORY, DIANA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:CORY
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 1:3959 BROADWAY, 7TH FLOOR NORTH
Mailing Address - Street 2:DIVISION OF CLINICAL GENETICS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-2684
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY, 7TH FLOOR NORTH
Practice Address - Street 2:DIVISION OF CLINICAL GENETICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 275371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical