Healthcare Provider Details

I. General information

NPI: 1558431650
Provider Name (Legal Business Name): DIANA YVONNE GINTNER FL: LCSW & SC PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA YVONNE CERVONE MA: LICSW & ED PSYCH

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 SE 11TH CT SUITE A
FT LAUDERDALE FL
33316-1111
US

IV. Provider business mailing address

514 SE 11TH CT SUITE A
FT LAUDERDALE FL
33316-1111
US

V. Phone/Fax

Practice location:
  • Phone: 954-732-8050
  • Fax:
Mailing address:
  • Phone: 954-732-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111950
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW 8747
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS 924
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberED PSY 963 ALLIED MH
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: