MEDICARE: MS. DIANE M LA CORTE LCSW

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
1	1041C0700X	Clinical Social Worker	SW6907	FL

General Provider Information

NPI Number	:	1740278340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE M LA CORTE LCSW

Provider Business Mailing Address
First Line	:	8349 NW 51ST MNR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2807
Country	:	US
Telephone Number	:	954-260-9948
Fax Number	:

Provider Business Practice Location Address
First Line	:	7501 WILES RD
Second Line	:	SUITE #102 B
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2063
Country	:	US
Telephone Number	:	954-260-9948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2005
Last Update Date	:	10/19/2011

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