| Doctor Name: | DIANA MELISA IDELSON |
| NPI Number: | 1003062415 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | |
| Business Practice Address: | 520 State Route 17m Monroe, NY - 109503455 |
| Business Phone Number: | 8457820295 |
| Business Fax Number: | 8457825164 |
| Mailing Address: | 520 State Route 17m, MONROE |
| State: | NY |
| Postal Code: | 109503455 |
| Phone Number: | 8457820295 |
| Fax Number: | 8457825164 |
| NPI Enumeration Date: | 08/18/2008 |
| NPI Last Update Date: | 08/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |