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Individual

MRS. COURTNEY ALISSA DIETRICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
255-03 75TH AVENUE, GLEN OAKS, NY 11004
(516) 458-4086
Mailing address
255-03 75TH AVENUE, GLEN OAKS, NY 11004
(516) 458-4086

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
075814-1
NY

Other

Enumeration date
06/02/2010
Last updated
06/02/2010
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