Provider Demographics
NPI:1558431650
Name:GINTNER, DIANA YVONNE (FL: LCSW & SC PSYCH)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:YVONNE
Last Name:GINTNER
Suffix:
Gender:F
Credentials:FL: LCSW & SC PSYCH
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:YVONNE
Other - Last Name:CERVONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA: LICSW & ED PSYCH
Mailing Address - Street 1:514 SE 11TH CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1111
Mailing Address - Country:US
Mailing Address - Phone:954-732-8050
Mailing Address - Fax:
Practice Address - Street 1:514 SE 11TH CT
Practice Address - Street 2:SUITE A
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1111
Practice Address - Country:US
Practice Address - Phone:954-732-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119501041C0700X
FLSW 8747104100000X
FLSS 924103TS0200X
MAED PSY 963 ALLIED MH103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool