Provider Demographics
NPI:1972974285
Name:CALICE, DIANA LEBLANC
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LEBLANC
Last Name:CALICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ROWAN DR
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1309
Mailing Address - Country:US
Mailing Address - Phone:845-536-2545
Mailing Address - Fax:
Practice Address - Street 1:68 2ND AVE
Practice Address - Street 2:APT C
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-4405
Practice Address - Country:US
Practice Address - Phone:845-536-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323548164W00000X
NY820561163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No164W00000XNursing Service ProvidersLicensed Practical Nurse