Provider Demographics
NPI:1407193873
Name:DIANA GENZONE, LMHC, P.A.
Entity Type:Organization
Organization Name:DIANA GENZONE, LMHC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENZONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-444-8052
Mailing Address - Street 1:3635 LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2248
Mailing Address - Country:US
Mailing Address - Phone:561-444-8052
Mailing Address - Fax:
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 302
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-444-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4672101YA0400X
FLMH 8474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty