Provider Demographics
NPI:1417371261
Name:SNOW, DIANE P (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:P
Last Name:SNOW
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 1:1005 WARD CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7005
Mailing Address - Country:US
Mailing Address - Phone:407-782-5092
Mailing Address - Fax:267-295-1929
Practice Address - Street 1:801 INTERNATIONAL PKWY FL 5
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4762
Practice Address - Country:US
Practice Address - Phone:407-782-5092
Practice Address - Fax:267-295-1929
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW124091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical