Provider Demographics
NPI:1104132265
Name:MANCINI, DIANA MARIA (LMSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIA
Last Name:MANCINI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIA
Other - Last Name:ROLDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3103
Mailing Address - Country:US
Mailing Address - Phone:518-431-1650
Mailing Address - Fax:518-447-0429
Practice Address - Street 1:102 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1543
Practice Address - Country:US
Practice Address - Phone:518-431-1650
Practice Address - Fax:518-447-0429
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078764-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical