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Provider Information for 1225808884


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DIANE MARIE CANTWELL LMHC


Sex: Female

NPI: 1225808884
Last Updated: 2024-01-05
Certification Date: 2024-01-05

Details

NameValue
NPI1225808884
Enumeration Date2024-01-04
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 94 BLACK EYED SUSAN RD
LANGHORNE, PA 19047-3418
United States

Phone: 818-505-4328 | Fax:
 
Primary Practice Address 15816 COBBLE MILL DR
WIMAUMA, FL 33598-4011
United States

Phone: 818-505-4328 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YS0200X - Counselor - SchoolFL620384
Yes 101YM0800X - Counselor - Mental HealthFL8326