Provider Demographics
NPI:1124109939
Name:MAKSA, DINARA (PHD)
Entity type:Individual
Prefix:DR
First Name:DINARA
Middle Name:
Last Name:MAKSA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DEEPDENE RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6061
Mailing Address - Country:US
Mailing Address - Phone:917-509-0139
Mailing Address - Fax:718-836-5147
Practice Address - Street 1:61 DEEPDENE RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6061
Practice Address - Country:US
Practice Address - Phone:917-509-0139
Practice Address - Fax:718-836-5147
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015776-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02547148Medicaid
NY02547148Medicaid
NY0340EDMedicare ID - Type UnspecifiedGHI MEDICARE
NYQ16968Medicare UPIN