Provider Demographics
NPI:1164456125
Name:LEFKOWITZ, DIANE ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELAINE
Last Name:LEFKOWITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 WATER OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8429
Mailing Address - Country:US
Mailing Address - Phone:954-985-4357
Mailing Address - Fax:954-986-2903
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE C-403D
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-986-4357
Practice Address - Fax:954-986-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00042451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7341Medicare ID - Type UnspecifiedLCSW