Provider Demographics
NPI:1750617585
Name:TANZOSH, DIANA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:TANZOSH
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 1:170 RADCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1225
Mailing Address - Country:US
Mailing Address - Phone:516-922-2919
Mailing Address - Fax:
Practice Address - Street 1:170 RADCLIFF DR
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1225
Practice Address - Country:US
Practice Address - Phone:516-922-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0375131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical