Provider Demographics
NPI:1629552575
Name:REDDISH, DIARA SOFIA
Entity Type:Individual
Prefix:
First Name:DIARA
Middle Name:SOFIA
Last Name:REDDISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIARA
Other - Middle Name:SOFIA
Other - Last Name:JUMA LUCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2850 FOREST HILLS BLVD APT 216
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5218
Mailing Address - Country:US
Mailing Address - Phone:786-378-1169
Mailing Address - Fax:
Practice Address - Street 1:409 S DIXIE HYW
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460
Practice Address - Country:US
Practice Address - Phone:561-409-3418
Practice Address - Fax:561-409-3418
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral