Provider Demographics
NPI:1689409377
Name:EDOUARD, DIANEVEN (LCSW)
Entity type:Individual
Prefix:
First Name:DIANEVEN
Middle Name:
Last Name:EDOUARD
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 1:308 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2568
Mailing Address - Country:US
Mailing Address - Phone:863-261-8354
Mailing Address - Fax:863-638-5637
Practice Address - Street 1:2151 45TH ST STE 210
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2015
Practice Address - Country:US
Practice Address - Phone:863-261-8354
Practice Address - Fax:863-638-5637
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical