Provider Demographics
NPI:1417381872
Name:ANDREOU, DIANE KELLY (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:KELLY
Last Name:ANDREOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4651 PINEMORE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6990
Mailing Address - Country:US
Mailing Address - Phone:954-649-4987
Mailing Address - Fax:
Practice Address - Street 1:1655 PALM BEACH LAKES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2203
Practice Address - Country:US
Practice Address - Phone:561-612-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical