Provider Demographics
NPI:1275971830
Name:BOSCOVICH, DIANA CORREA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CORREA
Last Name:BOSCOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 S 19TH CIR SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-7280
Mailing Address - Country:US
Mailing Address - Phone:915-731-5075
Mailing Address - Fax:
Practice Address - Street 1:130 S 19TH CIR SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-7280
Practice Address - Country:US
Practice Address - Phone:915-731-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW222331041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator