Provider Demographics
NPI:1982940490
Name:WESTBROOK, DICODA DIANDRA (LMSW)
Entity type:Individual
Prefix:MISS
First Name:DICODA
Middle Name:DIANDRA
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FRANKLIN ST
Mailing Address - Street 2:APARTMENT 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2913
Mailing Address - Country:US
Mailing Address - Phone:646-508-9458
Mailing Address - Fax:212-431-2415
Practice Address - Street 1:500 8TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6504
Practice Address - Country:US
Practice Address - Phone:212-904-1500
Practice Address - Fax:212-904-1515
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086332-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker