Provider Demographics
NPI:1154386456
Name:MATTHEW, DIANNE MINDY (MSW)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:MINDY
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1757
Mailing Address - Country:US
Mailing Address - Phone:561-852-3333
Mailing Address - Fax:561-852-3332
Practice Address - Street 1:21300 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1757
Practice Address - Country:US
Practice Address - Phone:561-852-3333
Practice Address - Fax:561-852-3332
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW27931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6972OtherBLUECROSS BLUE SHIELD FL
FLZ6972OtherBLUECROSS BLUE SHIELD FL