Individual
DIANCO LAVENSKI HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
8002 KEW GARDENS RD STE 704, KEW GARDENS, NY 11415-3607
(718) 520-1513
Mailing address
100 ACACIA AVE, HEMPSTEAD, NY 11550-7021
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
33557
NY
Other
Enumeration date
04/03/2019
Last updated
08/31/2021
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