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General NPI Number Information
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NPI Number | 1538692264
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Entity Type | Organization
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Legal Business Name | DIANE BADER-ANDERSON LCSW INC
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 8470 ENTERPRISE CIR SUITE 311
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-4102
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Country | US
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Telephone | 941-915-1594
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Fax | 941-870-1964
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Provider Business Mailing Address
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Address Line | 8470 ENTERPRISE CIR SUITE 311
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-4102
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Country | US
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Telephone | 941-915-1594
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Fax | 941-870-1964
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE BADER-ANDERSON
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Credential | LCSW
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Telephone | 941-915-1594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW12998
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License Number State | FL
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