Provider Demographics
NPI:1578890349
Name:BANDY, DIANE C (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:BANDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:CALLECOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1701 NE 42ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470
Mailing Address - Country:US
Mailing Address - Phone:813-290-8560
Mailing Address - Fax:
Practice Address - Street 1:1701 NE 42ND AVENUE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470
Practice Address - Country:US
Practice Address - Phone:813-290-8560
Practice Address - Fax:352-354-9166
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14506101YM0800X
OHI 07004141041C0700X
OHI.0700414-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health