Healthcare Provider Details

I. General information

NPI: 1144543786
Provider Name (Legal Business Name): DIANA LYNN GELFAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 JOE DIMAGGIO DR
HOLLYWOOD FL
33021-5402
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5324
  • Fax:
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: