| Doctor Name: | DR. MARC JOSHUA DIENER |
| NPI Number: | 1255632337 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 0810003955 |
| Business Practice Address: | 1800 Rockaway Ave Suite 206a Hewlett, NY - 115571665 |
| Business Phone Number: | 6462461662 |
| Business Fax Number: | 6468710203 |
| Mailing Address: | 1800 Rockaway Ave, Suite 206a HEWLETT |
| State: | NY |
| Postal Code: | 115571665 |
| Phone Number: | 6462461662 |
| Fax Number: | 6468710203 |
| NPI Enumeration Date: | 11/05/2010 |
| NPI Last Update Date: | 07/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0810003955 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |