Provider Demographics
NPI:1639309024
Name:MONROE, DIANA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 S POST RD APT 202
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3542
Mailing Address - Country:US
Mailing Address - Phone:754-281-2911
Mailing Address - Fax:239-332-4977
Practice Address - Street 1:390 PONDELLA RD STE 9
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4340
Practice Address - Country:US
Practice Address - Phone:239-652-0260
Practice Address - Fax:239-652-0146
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW55661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW5566OtherPROFESSIONAL LICENSE