Provider Demographics
NPI:1477736205
Name:DIANA MOORE, LCSW, P.A. GROUP
Entity Type:Organization
Organization Name:DIANA MOORE, LCSW, P.A. GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-784-8060
Mailing Address - Street 1:10714 PELICAN DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6154
Mailing Address - Country:US
Mailing Address - Phone:561-784-8060
Mailing Address - Fax:561-791-1805
Practice Address - Street 1:10714 PELICAN DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6154
Practice Address - Country:US
Practice Address - Phone:561-784-8060
Practice Address - Fax:561-791-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00004046251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management