Provider Demographics
NPI:1730574088
Name:DIANE A GARIEPY LCSW PC
Entity type:Organization
Organization Name:DIANE A GARIEPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:GARIEPY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR,ND
Authorized Official - Phone:631-642-7474
Mailing Address - Street 1:646 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2235
Mailing Address - Country:US
Mailing Address - Phone:631-642-7474
Mailing Address - Fax:
Practice Address - Street 1:460 OLD TOWN ROAD
Practice Address - Street 2:21-G
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-642-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty