Provider Demographics
NPI:1730902289
Name:DIAZ, CARMEN JULIA (BS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:JULIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GREEN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1483
Mailing Address - Country:US
Mailing Address - Phone:347-925-5978
Mailing Address - Fax:
Practice Address - Street 1:185 GREEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1406
Practice Address - Country:US
Practice Address - Phone:347-925-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst