Healthcare Provider Details

I. General information

NPI: 1003597618
Provider Name (Legal Business Name): CAMILA DIOSES MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 PGA BLVD STE 212
PALM BEACH GARDENS FL
33418-3945
US

IV. Provider business mailing address

7825 VENTURE CENTER WAY APT 4303
BOYNTON BEACH FL
33437-7405
US

V. Phone/Fax

Practice location:
  • Phone: 321-549-7414
  • Fax:
Mailing address:
  • Phone: 561-809-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW18799
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: