Individual
MS. DIANEA ALICE KOHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN,MFT
Contact information
Practice address
125 W GREEN ST, ITHACA, NY 14850-5419
(607) 277-6440
Mailing address
4 GRAY RD, ITHACA, NY 14850-8762
(607) 277-6440
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
000099-1
NY
163W00000X
Registered Nurse
212936-1
NY
Other
Enumeration date
05/22/2007
Last updated
10/29/2007
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