MEDICARE: MR. STEVEN DIAZ SR. LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	000887	CT
2	1041C0700X	Clinical Social Worker	11566	CT

General Provider Information

NPI Number	:	1346550050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN DIAZ SR. LCSW

Provider Business Mailing Address
First Line	:	1188 MAIN ST APT 324
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4039
Country	:	US
Telephone Number	:	203-565-4492
Fax Number	:	203-345-3331

Provider Business Practice Location Address
First Line	:	1000 LAFAYETTE BLVD FL 11
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4725
Country	:	US
Telephone Number	:	860-922-5034
Fax Number	:	203-345-3331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	03/31/2022

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