Healthcare Provider Details

I. General information

NPI: 1548762149
Provider Name (Legal Business Name): MS. TONI ANNETTE DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 FEDERAL ST
GREENFIELD MA
01301-1932
US

IV. Provider business mailing address

64 WALLINGFORD AVE
ATHOL MA
01331-1507
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-5411
  • Fax:
Mailing address:
  • Phone: 978-490-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: