Provider Demographics
NPI:1871569418
Name:ROSSI, DIANNE MICHELE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:MICHELE
Last Name:ROSSI
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 1:1 ALEXANDER STREET
Mailing Address - Street 2:1214
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-7568
Mailing Address - Country:US
Mailing Address - Phone:914-346-7490
Mailing Address - Fax:
Practice Address - Street 1:1 ALEXANDER STREET
Practice Address - Street 2:1214
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-7568
Practice Address - Country:US
Practice Address - Phone:914-346-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053233-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03074224Medicaid
NY03074224Medicaid
NYN363G1Medicare PIN