Provider Demographics
NPI:1225808884
Name:CANTWELL, DIANE MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BLACK EYED SUSAN RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3418
Mailing Address - Country:US
Mailing Address - Phone:818-505-4328
Mailing Address - Fax:
Practice Address - Street 1:15816 COBBLE MILL DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4011
Practice Address - Country:US
Practice Address - Phone:818-505-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL620384101YS0200X
FL8326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool