Healthcare Provider Details

I. General information

NPI: 1669673984
Provider Name (Legal Business Name): BARBARA TERESA DIAZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVE
TRENTON NJ
08638-3829
US

IV. Provider business mailing address

368 PARK AVE APT 2
PERTH AMBOY NJ
08861-3420
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax: 609-396-6024
Mailing address:
  • Phone: 908-599-3799
  • Fax: 609-396-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00076400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: