Provider Demographics
NPI:1407252026
Name:CARDONA, DIANA (RMHC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:RMHC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:3333 FOREST HILL BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5812
Mailing Address - Country:US
Mailing Address - Phone:305-562-8218
Mailing Address - Fax:
Practice Address - Street 1:3333 FOREST HILL BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5812
Practice Address - Country:US
Practice Address - Phone:305-562-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17522101YM0800X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105179100Medicaid