Provider Demographics
NPI:1003379603
Name:DIANE HALPERIN PA
Entity Type:Organization
Organization Name:DIANE HALPERIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:HALPERIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-866-5450
Mailing Address - Street 1:8198 S JOG RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-6903
Mailing Address - Country:US
Mailing Address - Phone:561-866-5450
Mailing Address - Fax:
Practice Address - Street 1:8198 S JOG RD STE 201
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-6903
Practice Address - Country:US
Practice Address - Phone:561-866-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty