Provider Demographics
NPI:1194899716
Name:HENRY, DIANE K (LCSW-R)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:HENRY
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 1:554 LARKFIELD RD
Mailing Address - Street 2:STE 10C
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4205
Mailing Address - Country:US
Mailing Address - Phone:631-923-8392
Mailing Address - Fax:
Practice Address - Street 1:554 LARKFIELD RD
Practice Address - Street 2:STE 10C
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4205
Practice Address - Country:US
Practice Address - Phone:631-923-8392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0698431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical