Provider Demographics
NPI:1518188788
Name:DIAZ RUBIO, LUIS FERMIN (LMHC)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:FERMIN
Last Name:DIAZ RUBIO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 DOCK ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2733
Mailing Address - Country:US
Mailing Address - Phone:914-965-1109
Mailing Address - Fax:914-965-9705
Practice Address - Street 1:35 DOCK ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-965-1109
Practice Address - Fax:914-965-9705
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008728101YM0800X
FLLMHC5613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health