Provider Demographics
NPI:1922163153
Name:JAGODA, DIANE JANE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JANE
Last Name:JAGODA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:ABBOTT
Other - Last Name:JAGODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:8970 OLDHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1109
Mailing Address - Country:US
Mailing Address - Phone:561-625-5778
Mailing Address - Fax:561-625-5992
Practice Address - Street 1:600 SANDTREE DR
Practice Address - Street 2:SUITE 202B
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1597
Practice Address - Country:US
Practice Address - Phone:561-626-4788
Practice Address - Fax:561-625-5992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW35481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5937Medicare PIN