Provider Demographics
NPI:1174964217
Name:GEORGES, DIANE KALI
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:KALI
Last Name:GEORGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 POWERHOUSE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2046
Mailing Address - Country:US
Mailing Address - Phone:347-772-8373
Mailing Address - Fax:
Practice Address - Street 1:97 POWERHOUSE RD STE 104
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2046
Practice Address - Country:US
Practice Address - Phone:347-772-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health