Healthcare Provider Details

I. General information

NPI: 1114500972
Provider Name (Legal Business Name): TESSA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MILTON ST STE 101
DEDHAM MA
02026-2927
US

IV. Provider business mailing address

260 MILTON ST STE 101
DEDHAM MA
02026-2927
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-3400
  • Fax:
Mailing address:
  • Phone: 508-478-0207
  • Fax: 508-634-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: