Healthcare Provider Details

I. General information

NPI: 1326584707
Provider Name (Legal Business Name): DIANA ROUSSO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 S STATE ROAD 7 STE 303
WELLINGTON FL
33449-8147
US

IV. Provider business mailing address

3319 S STATE ROAD 7 STE 303
WELLINGTON FL
33449-8147
US

V. Phone/Fax

Practice location:
  • Phone: 561-408-5598
  • Fax: 561-408-5598
Mailing address:
  • Phone: 561-408-5598
  • Fax: 561-408-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: