Active NPI
Diane T Colonnello, M.S.W.
- Clinical Social Worker
- Fort Myers, FL
National Provider Identifier
1073518973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW1700
- Practice address
- 8192 College Pkwy
Ste 50
Fort Myers, FL 33919-5405 - Phone
- (239) 275-9665
- Fax
- (239) 267-4438
- NPI assigned
- Jun 16, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW1700 | FL | Primary |
Addresses
Primary practice location
8192 College Pkwy
Ste 50
Fort Myers, FL 33919-5405
Mailing address
8192 College Pkwy
Ste. 50
Fort Myers, FL 33919
Phone (239) 275-9665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2019 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW1700 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282608000000",
"number": "1073518973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8192 COLLEGE PKWY",
"address_2": "STE. 50",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "33919",
"telephone_number": "239-275-9665",
"fax_number": "239-267-4438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8192 COLLEGE PKWY",
"address_2": "STE 50",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339195405",
"telephone_number": "239-275-9665",
"fax_number": "239-267-4438"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLONNELLO",
"first_name": "DIANE",
"middle_name": "T",
"name_prefix": "Ms.",
"credential": "M.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-06-16",
"last_updated": "2010-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW1700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.