Healthcare Provider Details

I. General information

NPI: 1922923820
Provider Name (Legal Business Name): SANDRA DIAZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 SALISBURY RD
JACKSONVILLE FL
32256-6107
US

IV. Provider business mailing address

PO BOX 1971
BELLE GLADE FL
33430-6971
US

V. Phone/Fax

Practice location:
  • Phone: 561-618-5428
  • Fax:
Mailing address:
  • Phone: 561-618-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: