Provider Demographics
NPI:1447502695
Name:MARTINS-MANDEL, DIANE P (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:MARTINS-MANDEL
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 1:66 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5029
Mailing Address - Country:US
Mailing Address - Phone:914-589-6928
Mailing Address - Fax:
Practice Address - Street 1:560 WHITE PLAINS RD STE 215
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5113
Practice Address - Country:US
Practice Address - Phone:914-359-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084902-11041C0700X
NY090101104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWVE061OtherAGENCY MEDICARE
NY1285628552OtherAGENCY NPI
NY00355940OtherAGENCY MEDICAID