Provider Demographics
NPI:1508017146
Name:DIETSCH, TAIMARA (MS)
Entity Type:Individual
Prefix:
First Name:TAIMARA
Middle Name:
Last Name:DIETSCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N KROME AVE
Mailing Address - Street 2:200
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4400
Mailing Address - Country:US
Mailing Address - Phone:305-771-5321
Mailing Address - Fax:
Practice Address - Street 1:950 N KROME AVE
Practice Address - Street 2:200
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4400
Practice Address - Country:US
Practice Address - Phone:305-771-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health