Provider Demographics
NPI:1952567091
Name:GRODNEY, DIANE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:GRODNEY
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W 18TH ST
Mailing Address - Street 2:C/O DR. NELSON, 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4422
Mailing Address - Country:US
Mailing Address - Phone:646-498-3007
Mailing Address - Fax:
Practice Address - Street 1:305 W 18TH ST
Practice Address - Street 2:C/O DR. NELSON, 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4422
Practice Address - Country:US
Practice Address - Phone:646-498-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019348104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker