Individual
DIANE VAILLANCOURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2857 LINDEN BLVD, BROOKLYN, NY 11208-5126
(718) 235-3100
(718) 277-0822
Mailing address
21 NIEMAN AVE, LYNBROOK, NY 11563-2057
(516) 887-4529
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
03/11/2013
Last updated
03/11/2013
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