Provider Demographics
NPI:1437185741
Name:NOMIKOS-KATZ, DIANA (PSY D)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NOMIKOS-KATZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 723
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4030
Mailing Address - Country:US
Mailing Address - Phone:954-491-4455
Mailing Address - Fax:954-840-8254
Practice Address - Street 1:2400 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 723
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4030
Practice Address - Country:US
Practice Address - Phone:954-491-4455
Practice Address - Fax:954-840-8254
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6662103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1767ZMedicare PIN
FLU1767Medicare UPIN