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NPI Code Detail

MEDICARE: DIANNE MINDY MATTHEW MSW

MEDICARE: DIANNE MINDY MATTHEW MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW2793FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z6972OTHERFLBLUECROSS BLUE SHIELD FL

General Provider Information

NPI Number : 1154386456
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE MINDY MATTHEW MSW
Provider Business Mailing Address
First Line : 21300 COLEMAN BLVD
Second Line :
City : BOCA RATON
State : FL
Zip : 33428-1757
Country : US
Telephone Number : 561-852-3333
Fax Number : 561-852-3332
Provider Business Practice Location Address
First Line : 21300 COLEMAN BLVD
Second Line :
City : BOCA RATON
State : FL
Zip : 33428-1757
Country : US
Telephone Number : 561-852-3333
Fax Number : 561-852-3332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 09/30/2008

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