Provider Demographics
NPI:1760753222
Name:GENZONE, DIANA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:GENZONE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 LAKEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2248
Mailing Address - Country:US
Mailing Address - Phone:954-415-0602
Mailing Address - Fax:
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 302
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:954-415-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4672101YA0400X
FLMH 8474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)