Provider Demographics
NPI:1699077891
Name:DIANE M. DIGERONIMO, LCSW, PA
Entity type:Organization
Organization Name:DIANE M. DIGERONIMO, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIGERONIMO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-230-3023
Mailing Address - Street 1:321 OCEAN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2569
Mailing Address - Country:US
Mailing Address - Phone:321-230-3023
Mailing Address - Fax:
Practice Address - Street 1:321 OCEAN AVE STE 107
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-2569
Practice Address - Country:US
Practice Address - Phone:321-230-3023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2670Medicare PIN