Provider Demographics
NPI:1629363510
Name:GERONEMUS, DIANN FOX (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANN
Middle Name:FOX
Last Name:GERONEMUS
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 1:2808 NE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:954-564-1371
Practice Address - Street 1:2808 NE 22ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-2804
Practice Address - Country:US
Practice Address - Phone:954-564-9460
Practice Address - Fax:954-564-1371
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical