Provider Demographics
NPI:1881041903
Name:BARRETO, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BARRETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 CRACKER CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-7746
Mailing Address - Country:US
Mailing Address - Phone:407-749-2712
Mailing Address - Fax:
Practice Address - Street 1:4205 CRACKER CT
Practice Address - Street 2:
Practice Address - City:ST.CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772
Practice Address - Country:US
Practice Address - Phone:407-749-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health