Provider Demographics
NPI:1811000672
Name:GROSE, DIANE (MA LMHC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:GROSE
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:PILATOVSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMHC
Mailing Address - Street 1:117 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5707
Mailing Address - Country:US
Mailing Address - Phone:407-697-0220
Mailing Address - Fax:407-772-0228
Practice Address - Street 1:117 CAMBRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5707
Practice Address - Country:US
Practice Address - Phone:407-697-0220
Practice Address - Fax:407-772-0228
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health