Provider Demographics
NPI:1982760047
Name:DIETZ, BARBARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:DIETZ
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 1:307 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4905
Mailing Address - Country:US
Mailing Address - Phone:718-243-9254
Mailing Address - Fax:718-596-0592
Practice Address - Street 1:111 W 57TH ST
Practice Address - Street 2:SUITE 1422
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2211
Practice Address - Country:US
Practice Address - Phone:212-399-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0469961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical