Provider Demographics
NPI:1588964597
Name:MALKIN, DIANE BERS (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:BERS
Last Name:MALKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HUNTLEY DR
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1614
Mailing Address - Country:US
Mailing Address - Phone:917-881-0168
Mailing Address - Fax:
Practice Address - Street 1:547 SAW MILL RIVER RD STE 3F
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2154
Practice Address - Country:US
Practice Address - Phone:914-920-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0780811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical