Provider Demographics
NPI:1497017107
Name:LEVIN, DIANA DAVIDA (SPECEDTHERAPIST)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:DAVIDA
Last Name:LEVIN
Suffix:
Gender:F
Credentials:SPECEDTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2812
Mailing Address - Country:US
Mailing Address - Phone:516-316-6013
Mailing Address - Fax:
Practice Address - Street 1:449 FRANK ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2812
Practice Address - Country:US
Practice Address - Phone:516-316-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency