Provider Demographics
NPI:1255885000
Name:O'RORKE, DIANE (FL-CBA)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:O'RORKE
Suffix:
Gender:F
Credentials:FL-CBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9277 SW 136TH STREET CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5846
Mailing Address - Country:US
Mailing Address - Phone:305-667-7790
Mailing Address - Fax:
Practice Address - Street 1:9277 SW 136TH STREET CIR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5846
Practice Address - Country:US
Practice Address - Phone:305-667-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0517103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0517OtherFL-CBA