Provider Information for 1831390137
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Ms. KATE DIFFLEY JANCOVIC LCSW
Sex: Female
NPI: 1831390137
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1831390137 | ||||||||
| Enumeration Date | 2007-05-31 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4360 DOUGLASTON PKWY DOUGLASTON, NY 11363-1838 United States Phone: 718-423-3059 | Fax: | ||||||||
| Primary Practice Address | 480 OLD WESTBURY RD ROSLYN HEIGHTS, NY 11577-2215 United States Phone: 516-299-5373 | Fax: | ||||||||
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