Provider Demographics
NPI:1003645060
Name:WILE, DIANA MARCELA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARCELA
Last Name:WILE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:MARCELA
Other - Last Name:WILE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:7284 W PALMETTO PARK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3406
Mailing Address - Country:US
Mailing Address - Phone:954-829-3280
Mailing Address - Fax:
Practice Address - Street 1:7284 W PALMETTO PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3406
Practice Address - Country:US
Practice Address - Phone:954-829-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty