Provider Demographics
NPI:1285995357
Name:SALAZAR, DIANA MILENA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MILENA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 BONITA BEACH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4105
Mailing Address - Country:US
Mailing Address - Phone:239-954-7722
Mailing Address - Fax:239-443-4577
Practice Address - Street 1:3575 BONITA BEACH RD STE 102
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4105
Practice Address - Country:US
Practice Address - Phone:239-954-7722
Practice Address - Fax:239-443-4577
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW126861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1117901Medicaid
FL1699152553OtherBUSINESS NPI
FL014047700Medicaid