Healthcare Provider Details

I. General information

NPI: 1467878652
Provider Name (Legal Business Name): DIANA MONZON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 CHILDREN'S WAY
ENTERPRISE FL
32725
US

IV. Provider business mailing address

51 CHILDRENS WAY
ENTERPRISE FL
32725-8135
US

V. Phone/Fax

Practice location:
  • Phone: 386-668-4774
  • Fax:
Mailing address:
  • Phone: 386-668-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: