Healthcare Provider Details

I. General information

NPI: 1871602425
Provider Name (Legal Business Name): DIANE T HALPERIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8699 WOODGROVE HARBOR LN
BOYNTON BEACH FL
33437-4841
US

IV. Provider business mailing address

8198 S JOG RD STE 201
BOYNTON BEACH FL
33472-6903
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-5450
  • Fax:
Mailing address:
  • Phone: 561-866-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: