Healthcare Provider Details

I. General information

NPI: 1285286047
Provider Name (Legal Business Name): CINTHIA DIAZ-RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BEVERLY COMMONS DR APT 36
BEVERLY MA
01915-5559
US

IV. Provider business mailing address

110 BOSTON ST
SALEM MA
01970-1402
US

V. Phone/Fax

Practice location:
  • Phone: 978-223-8077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number101YM0800X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: