Provider Demographics
NPI:1841258670
Name:VERGARA, DIANA (PHD, PSYD, LMHC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VERGARA
Suffix:
Gender:F
Credentials:PHD, PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 NW 8TH ST
Mailing Address - Street 2:APT. 403
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3757
Mailing Address - Country:US
Mailing Address - Phone:305-262-3347
Mailing Address - Fax:
Practice Address - Street 1:9700 S DIXIE HWY
Practice Address - Street 2:SUITE 650
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2800
Practice Address - Country:US
Practice Address - Phone:305-670-1911
Practice Address - Fax:305-670-2049
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health