Individual provider · NPI-1

Dr. Marc Joshua Diener, Ph.D.

Psychologist · Hewlett, NY

NPI number1255632337
StatusActive
Last updated in NPPESJul 10, 2013

Details

NPI
1255632337
Entity type
Individual (NPI-1)
Name
Dr. Marc Joshua Diener
Credential
Ph.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 5, 2010
Last updated
Jul 10, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103T00000X Psychologist68017465NYYes
103TC0700X Psychologist, Clinical0810003955VA

Practice location

1800 Rockaway Ave
Suite 206a
Hewlett, NY 11557-1665

Phone 646-246-1662 · Fax 646-871-0203

Mailing address

1800 Rockaway Ave
Suite 206a
Hewlett, NY 11557-1665

Phone 646-246-1662 · Fax 646-871-0203

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