Provider Demographics
NPI:1144244039
Name:SIMON, DIANE NADLER (LMHC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:NADLER
Last Name:SIMON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14431 FAIRFAX PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6331
Mailing Address - Country:US
Mailing Address - Phone:954-475-1638
Mailing Address - Fax:954-475-1638
Practice Address - Street 1:17901 NW 5TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:954-540-1638
Practice Address - Fax:954-475-1638
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 00491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health