Provider Demographics
NPI:1194898163
Name:GOLDSTEIN, DIANA JOY (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:JOY
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 STARCREST DR APT W3
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4706
Mailing Address - Country:US
Mailing Address - Phone:210-380-7144
Mailing Address - Fax:210-590-7911
Practice Address - Street 1:2A MARGARET LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2825
Practice Address - Country:US
Practice Address - Phone:631-421-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047955-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical