Healthcare Provider Details

I. General information

NPI: 1639309024
Provider Name (Legal Business Name): DIANA MONROE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PONDELLA RD STE 9
NORTH FORT MYERS FL
33903-4340
US

IV. Provider business mailing address

16100 S POST RD APT 202
WESTON FL
33331-3542
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-0260
  • Fax: 239-652-0146
Mailing address:
  • Phone: 754-281-2911
  • Fax: 239-332-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: