Healthcare Provider Details

I. General information

NPI: 1912367137
Provider Name (Legal Business Name): YINI DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 BROAD ST
PROVIDENCE RI
02907-1465
US

IV. Provider business mailing address

PO BOX 746088
ATLANTA GA
30374-6088
US

V. Phone/Fax

Practice location:
  • Phone: 401-233-5060
  • Fax:
Mailing address:
  • Phone: 469-727-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISWO3263
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW03263
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: