Provider Demographics
NPI:1386436178
Name:DIEGELMAN, SALLY (MAED, LMHC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:DIEGELMAN
Suffix:
Gender:F
Credentials:MAED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WELLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2528
Mailing Address - Country:US
Mailing Address - Phone:716-445-1360
Mailing Address - Fax:
Practice Address - Street 1:280 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1127
Practice Address - Country:US
Practice Address - Phone:716-673-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015840-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health