Healthcare Provider Details

I. General information

NPI: 1215572037
Provider Name (Legal Business Name): DIANA NOMIKOS KATZ PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E COMMERCIAL BLVD 723
FT LAUDERDALE FL
33308-4131
US

IV. Provider business mailing address

4832 NW 20TH PL
COCONUT CREEK FL
33063-7751
US

V. Phone/Fax

Practice location:
  • Phone: 954-449-5232
  • Fax: 954-840-8254
Mailing address:
  • Phone: 954-224-0555
  • Fax: 954-840-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MISS DIANA NOMIKOS KATZ
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSY.D
Phone: 954-449-5232